Individual
ANGELA L REVERCOMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 NORTHSIDE AVE STE 375, HENRICO, VA 23228-5441
(804) 229-3172
Mailing address
7901 ANOKA RD, HENRICO, VA 23229-3305
(804) 229-3172
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
071003714
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104858653
—
VA
Enumeration date
03/17/2008
Last updated
11/11/2019
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