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NPI Code Detail

MEDICARE: REVIVE CLINIC LLC

MEDICARE: REVIVE CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number : 1689529398
Entity Type Code : Organization
Provider Name (Legal Business Name) : REVIVE CLINIC LLC
Provider Business Mailing Address
First Line : 211 N UNION ST STE 100
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-2643
Country : US
Telephone Number : 240-744-0540
Fax Number : 269-210-2598
Provider Business Practice Location Address
First Line : 211 N UNION ST STE 100
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-2643
Country : US
Telephone Number : 240-744-0540
Fax Number : 269-210-2598
Authorized Official
Title or Position : OWNER/PROVIDER
Name : DENISHA CUFFEE
Credential : NP
Telephone Number : 240-744-0540
Provider Enumeration Date : 02/27/2026
Last Update Date : 03/12/2026

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Directions to “REVIVE CLINIC LLC ” Practice Location

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