Healthcare Provider Details

I. General information

NPI: 1154256352
Provider Name (Legal Business Name): REVIVE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 PINEY FOREST RD
DANVILLE VA
24540-4060
US

IV. Provider business mailing address

490 PINEY FOREST RD
DANVILLE VA
24540-4060
US

V. Phone/Fax

Practice location:
  • Phone: 434-728-2641
  • Fax: 434-797-1096
Mailing address:
  • Phone: 434-728-2641
  • Fax: 434-797-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HARPER GIBSON
Title or Position: CEO/OWNER
Credential: GIBSON
Phone: 434-728-2641