Active NPI
Revere Counseling and Care Management LLC
- Social Worker
- Decatur, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- CSW002619
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie Lynn Roach, LCSW
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180807003302 | GA | Part B Supplier - Clinic/Group Practice | 3577811520 |
Receives reassigned benefits from 7 practitioners Practice locations: Decatur, GA |
National Provider Directory
National Provider DirectoryLocations
315 W Ponce de Leon Ave
Ste 370
Decatur, GA 30030
Phone (404) 281-5422
235 E Ponce de Leon Ave
Ste 330
Decatur, GA 30030
Phone (404) 301-9450
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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.