Reevolve

Key facts

NPI

1356881908

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Social Worker 1041C0700X

License

0904007067 (VA)

Legal business name

REEVOLVE

Practice address

44121 Harry Byrd Hwy Ste 170
Ashburn, VA 20147-5671

Phone

(703) 340-8936

NPI assigned

Mar 1, 2017

Organization subpart

No

Authorized official

Name

Garnet Nelson NPI 1730328766

Title

Director

Phone

(703) 340-8936

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

Practitioners 5

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

• Garnet Nelson, LCSW-C Clinical Social Worker · Ashburn, VA · NPI 1730328766
  NPD (past) Authorized official CLINICAL
• Suzanne A Guiragoss Mental Health Counselor · Ashburn, VA · NPI 1447862388
  NPD (past) MENTAL HEALTH
• Adrianne L Atwater, LICSW Social Worker · Washington, DC · NPI 1801054994
  NPD (past)
• Elizabeth C Krueger Clinical Social Worker · Silver Spring, MD · NPI 1700363223
  NPD (past) CLINICAL
• Kevin Dana Morton, LICSW Clinical Social Worker · Washington, DC · NPI 1124132469
  NPD (past) CLINICAL

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 1, 2017.

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1356881908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44121 HARRY BYRD HWY STE 170",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475671",
            "telephone_number": "703-340-8936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44121 HARRY BYRD HWY STE 170",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475671",
            "telephone_number": "703-340-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REEVOLVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-01",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "GARNET",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-340-8936"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14604",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007067",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730328766",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashburn, VA

• Recharge Wellness
• Redeemed Way Christian Counseling, LLC
• Ellen Christine Redling, RN,CS,MS
• Jonathan Reed
• Carter Cornette Reeves, DDS
• Taylor Rehfuss, PA-C
• Michele Quintana Reilly, DO
• Renal Treatment Centers Mid Atlantic Inc
• Mary R Renard, MD
• Renee Haynesworth, MD

All providers in Ashburn, VA · Clinical Social Worker in Virginia