MEDICARE: DR. VIRGINIA L REVERE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0810000939	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538174107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA L REVERE PH.D.

Provider Business Mailing Address
First Line	:	9012 LINTON LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2733
Country	:	US
Telephone Number	:	703-780-4872
Fax Number	:

Provider Business Practice Location Address
First Line	:	9012 LINTON LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2733
Country	:	US
Telephone Number	:	703-780-4872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	10/07/2011

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