Revitalize Behavioral Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

REVITALIZE BEHAVIORAL SERVICES, LLC

Doing business as

Revitalize Behavioral Services, LLC

Practice address

5215 Colley Ave
Norfolk, VA 23508-2166

Phone

(757) 553-8416

NPI assigned

Oct 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jessica Valdivia, QMHP-C/A

Title

Owner

Phone

(757) 553-8416

Specialties & licenses 1

Addresses

Other names 1

• Revitalize Behavioral Services, LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1174342950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4608 MAYFLOWER RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082740",
            "telephone_number": "757-553-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 COLLEY AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082166",
            "telephone_number": "757-553-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE BEHAVIORAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "VALDIVIA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-553-8416",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "QMHP-C/A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revitalize Behavioral Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rewired Canvas Psychotherapy LLC
• Amber Lynn Reyes, PA
• James Reyes
• Janet A Reyes

• Community/Behavioral Health Agency in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.