Healthcare Provider Details

I. General information

NPI: 1295661742
Provider Name (Legal Business Name): REVIVE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7336 PORT SIDE DR
MIDLOTHIAN VA
23112-2150
US

IV. Provider business mailing address

7336 PORT SIDE DR
MIDLOTHIAN VA
23112-2150
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-0228
  • Fax:
Mailing address:
  • Phone: 804-893-0228
  • Fax: 804-639-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE L. HIGHSMITH
Title or Position: OWNER
Credential: LPC
Phone: 804-893-0228