Revival Wellness & Ketamine

NPI #1093514655 in Chantilly, Virginia

Provider Information

NPI Number: 1093514655
Entity Type: Organization
Organization Name: Revival Wellness & Ketamine
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Mar 7, 2025
Last Updated: Nov 3, 2025

Practice Location

Address: 4200B TECHNOLOGY CT
City: Chantilly
State: Virginia
ZIP Code: 20151-1214
Phone: (703) 988-3984

Authorized Official

Name: NICOLE WATSON, PMHNP, CRNA
Title: FOUNDER
Phone: (703) 988-3984

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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