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General NPI Number Information
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NPI Number | 1003797176
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Entity Type | Organization
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Legal Business Name | REVIVE CLINIC LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 10101 TWIN RIVERS ROAD APT 401
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City | COLUMBIA
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State | MD
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Zip | 21044
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Country | US
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Telephone | 443-328-4810
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Fax | 269-210-2598
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Provider Business Mailing Address
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Address Line | 5457 TWIN KNOLLS RD STE 300
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City | COLUMBIA
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State | MD
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Zip | 21045-3296
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Country | US
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Telephone | 443-328-4810
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Fax | 269-210-2598
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DENISHA CUFFEE
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Credential | NP
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Telephone | 443-328-4810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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