Revival Wellness & Ketamine
NPI 1093514655 · Mental Health Clinic/Center (Including Community Mental Health Center) · Chantilly, VA
Revival Wellness & Ketamine is a Mental Health Clinic/Center (Including Community Mental Health Center) organization in Chantilly, VA (NPI 1093514655).
Provider details
- NPI number
- 1093514655
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Nicole Watson, Founder(703) 988-3984
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2025-03-07
- Last updated
- 2025-11-03
- Certified
- 2025-11-03
Frequently asked questions
- What is Revival Wellness & Ketamine's NPI number?
- Revival Wellness & Ketamine's National Provider Identifier (NPI) is 1093514655, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Revival Wellness & Ketamine?
- Revival Wellness & Ketamine is classified in the NPPES registry as Mental Health Clinic/Center (Including Community Mental Health Center) (Ambulatory Health Care Facilities).
- Where is Revival Wellness & Ketamine located?
- Revival Wellness & Ketamine's practice location on file with NPPES is 4200b Technology Ct, Chantilly, VA 20151-1214.
- What is Revival Wellness & Ketamine's phone number?
- The practice phone number listed in the NPPES registry for Revival Wellness & Ketamine is (703) 988-3984.
- Who is the authorized official for Revival Wellness & Ketamine?
- The authorized official listed on Revival Wellness & Ketamine's NPPES record is Nicole Watson, Founder. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Revival Wellness & Ketamine's NPI active?
- Yes — Revival Wellness & Ketamine's NPI (1093514655) is active in the NPPES registry as of the last update on 2025-11-03.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.