Revered-Holistic Healthcare LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REVERED-HOLISTIC HEALTHCARE LLC

Practice address

9861 Broken Land Pkwy Ste 100
Columbia, MD 21046-3031

Phone

(410) 399-4240

Fax

(443) 381-0216

NPI assigned

May 4, 2023

Organization subpart

No

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

Authorized official

Name

Adetutu Awodipe, PMHNPNPI 1386157857

Title

President

Phone

(443) 621-2203

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Revered-Holistic Healthcare LLC

  • Family Nurse Practitioner
  • Columbia, MD
  • NPI 1700377876

  O20180802000064

  Same enrollment

Tax ID family

Revered Holistic Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Revered-Holistic Healthcare LLC

  • Family Nurse Practitioner
  • Columbia, MD
  • NPI 1700377876
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adetutu Awodipe, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Columbia, MD
  • NPI 1386157857

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1205525334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518 RUNNYMEADE RD",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211176156",
            "telephone_number": "410-399-4240",
            "fax_number": "443-381-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9861 BROKEN LAND PKWY STE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463031",
            "telephone_number": "410-399-4240",
            "fax_number": "443-381-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERED-HOLISTIC HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "AWODIPE",
        "authorized_official_first_name": "ADETUTU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-621-2203",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Ann Resch, M.AC., L.AC.
• Amy Marlene Respondek, DDS
• Lauren Restaino, CRNP
• Restore & Thrive LLC.
• Cristina Restrepo-Harner
• Revered-Holistic Healthcare LLC
• Revive Clinic LLC
• Revolution Sports Medicine
• Jeanine Paulette Sioson Reyes-Bautista, M.D.
• Camila Reyes-Loayza

• Mental Health Clinic/Center (Including Community Mental Health Center) in Columbia, MD
• Providers in Columbia, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.