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General NPI Number Information
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NPI Number | 1366325466
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Entity Type | Organization
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Legal Business Name | REVIVE AND THRIVE COUNSELING, PLLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 11710 PLAZA AMERICA DR STE 2000
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City | RESTON
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State | VA
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Zip | 20190-4743
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Country | US
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Telephone | 703-829-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 LAKINHURST LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1727
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Country | US
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Telephone | 703-829-6554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE DIAZ
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Credential | LPC
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Telephone | 703-829-6554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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