NPIMap

Organization Active NPI

Revere Counseling and Care Management LLC

  • Social Worker
  • Decatur, GA
National Provider Identifier
1114429412
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
CSW002619 Issued in GA
Legal business name
REVERE COUNSELING AND CARE MANAGEMENT LLC
Practice address
235 E Ponce de Leon Ave Ste 330
Decatur, GA 30030-3452
Phone
(404) 281-5422
NPI assigned
Mar 2, 2018
Last updated
Jul 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Lynn Roach, LCSWNPI 1689182263
Title
Owner
Phone
(404) 736-3793

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X CSW002619 GA Primary

Addresses

Primary practice location

235 E Ponce de Leon Ave Ste 330
Decatur, GA 30030-3452

Mailing address

235 E Ponce de Leon Ave Ste 330
Decatur, GA 30030-3452
Phone (404) 281-5422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180807003302 GA Part B Supplier - Clinic/Group Practice 3577811520 Receives reassigned benefits from 7 practitioners
Practice locations: Decatur, GA

National Provider Directory

National Provider Directory

Locations

235 E Ponce de Leon Ave
Ste 330
Decatur, GA 30030
Phone (404) 281-5422

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1114429412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E PONCE DE LEON AVE STE 330",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303452",
            "telephone_number": "404-281-5422",
            "fax_number": "404-377-0750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E PONCE DE LEON AVE STE 330",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303452",
            "telephone_number": "404-281-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE COUNSELING AND CARE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-736-3793",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "GA",
            "license": "CSW002619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.