Provider Demographics
NPI:1275323263
Name:REVINE CARE LLC
Entity type:Organization
Organization Name:REVINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-829-1111
Mailing Address - Street 1:4849 FORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1509
Mailing Address - Country:US
Mailing Address - Phone:434-279-3586
Mailing Address - Fax:434-279-3586
Practice Address - Street 1:4849 FORT AVE STE A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-1509
Practice Address - Country:US
Practice Address - Phone:434-279-3586
Practice Address - Fax:434-279-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty