NPIMap

Organization Active NPI

Angela Revercomb LPC LLC

  • Professional Counselor
  • Henrico, VA
National Provider Identifier
1386405645
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
ANGELA REVERCOMB LPC LLC
Doing business as
Angela Revercomb LPC LLC
Practice address
3111 Northside Ave Ste 375
Henrico, VA 23228-5441
Phone
(804) 955-8617
NPI assigned
Jan 23, 2024
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Ms. Angela Revercomb, LPCNPI 1700057825
Title
Owner/Provider
Phone
(804) 955-8617

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

3111 Northside Ave Ste 375
Henrico, VA 23228-5441

Mailing address

7901 Anoka Rd
Richmond, VA 23229-3305
Phone (804) 229-3172

Other names 1

  • ANGELA REVERCOMB LPC LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240313002669 VA Part B Supplier - Clinic/Group Practice 1951747880 Receives reassigned benefits from 1 practitioner
Practice locations: Henrico, VA

National Provider Directory

National Provider Directory

Locations

3111 Northside Ave
Ste 375
Henrico, VA 23228
Phone (804) 229-3172

Practitioners & affiliated clinicians

Practitioners 1

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": "1705968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1386405645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 ANOKA RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232293305",
            "telephone_number": "804-229-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 NORTHSIDE AVE STE 375",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232285441",
            "telephone_number": "804-955-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA REVERCOMB LPC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "REVERCOMB",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "804-955-8617",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANGELA REVERCOMB LPC LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henrico, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.