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Organization
REEVOLVE
Active
Organization
REEVOLVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARNET NELSON (DIRECTOR)
(703) 340-8936
Entity
Organization
Contact information
Practice address
44121 HARRY BYRD HWY STE 170, ASHBURN, VA 20147-5671
(703) 340-8936
Mailing address
44121 HARRY BYRD HWY STE 170, ASHBURN, VA 20147-5671
(703) 340-8936
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
0904007067
VA
1041C0700X
Clinical Social Worker
14604
MD
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730328766
—
VA
Enumeration date
03/01/2017
Last updated
03/01/2017
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