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General NPI Number Information
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NPI Number | 1356881908
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Entity Type | Organization
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Legal Business Name | REEVOLVE
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 44121 HARRY BYRD HWY STE 170
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City | ASHBURN
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State | VA
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Zip | 20147-5671
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Country | US
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Telephone | 703-340-8936
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Fax |
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Provider Business Mailing Address
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Address Line | 44121 HARRY BYRD HWY STE 170
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City | ASHBURN
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State | VA
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Zip | 20147-5671
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Country | US
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Telephone | 703-340-8936
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARNET NELSON
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Credential |
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Telephone | 703-340-8936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14604
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License Number State | MD
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Taxonomy #7
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007067
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License Number State | VA
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