Provider Demographics
NPI:1760292759
Name:ATIVED COUNSELING GROUP
Entity type:Organization
Organization Name:ATIVED COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVITA
Authorized Official - Middle Name:DENESE
Authorized Official - Last Name:BREVARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW
Authorized Official - Phone:240-715-8804
Mailing Address - Street 1:440 MONTICELLO AVE STE 1802
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2670
Mailing Address - Country:US
Mailing Address - Phone:240-715-8804
Mailing Address - Fax:
Practice Address - Street 1:250 AMERICAN WAY APT 443
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-4533
Practice Address - Country:US
Practice Address - Phone:240-715-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty