Revive Therapeutic Counseling Services

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

REVIVE THERAPEUTIC COUNSELING SERVICES

Doing business as

Revive Behavioral Health Solutions
Revive Wellness
Revive Wellness Inc

Practice address

2255 Crain Hwy Ste 105
Waldorf, MD 20601-3186

Phone

(301) 276-1151

Fax

(301) 923-1329

NPI assigned

Aug 4, 2022

Organization subpart

Yes

Parent organization

REVIVE THERAPEUTIC COUNSELING SERVICESAs reported in NPPES

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

Authorized official

Name

Camille A LewisNPI 1912357245

Title

Clinical Director

Phone

(301) 276-1151

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 3

• Revive Behavioral Health Solutions Doing business as
• Revive Wellness Doing business as
• Revive Wellness Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Part of

Revive Therapeutic Services LLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Camille A Lewis

  • Mental Health Counselor
  • Waldorf, MD
  • NPI 1912357245
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771718400000",
    "number": "1609503192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 CRAIN HWY STE 105",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013186",
            "telephone_number": "301-276-1151",
            "fax_number": "301-923-1329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 CRAIN HWY STE 105",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013186",
            "telephone_number": "301-276-1151",
            "fax_number": "301-923-1329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Eisenhower Ave Ste 220",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223144587",
            "country_code": "US",
            "telephone_number": "301-609-2675 x61151",
            "fax_number": "301-923-1329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 E Las Olas Blvd",
            "address_purpose": "LOCATION",
            "city": "Ft Lauderdale",
            "state": "FL",
            "postal_code": "333012296",
            "country_code": "US",
            "telephone_number": "301-609-2675",
            "fax_number": "301-923-1329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE THERAPEUTIC COUNSELING SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REVIVE THERAPEUTIC COUNSELING SERVICES",
        "enumeration_date": "2022-08-04",
        "last_updated": "2026-02-22",
        "certification_date": "2026-02-22",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "301-276-1151"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999013500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Behavioral Health Solutions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Wellness Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Mental Health Clinic/Center in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Adult Mental Health Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.