Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revival Wellness & Ketamine

Organization Mental Health Clinic/Center (Including Community Mental Health Center) · NPI 1093514655

Revival Wellness & Ketamine is a Mental Health Clinic/Center (Including Community Mental Health Center) in Chantilly, Virginia. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

4200B Technology Ct
Chantilly, VA 20151-1214
Phone: (703) 988-3984
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Clinic/Center (Including Community Mental Health Center) (primary) Taxonomy 261QM0801X

Record details

NPI number1093514655
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Nicole Watson — Founder · (703) 988-3984
NPI enumeratedMarch 7, 2025
Last updated in NPPESNovember 3, 2025
Certification dateNovember 3, 2025
Mailing address4200b Technology Ct, Chantilly, VA 20151-1214

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