| Revive Behavioral Health | |
|
416 3rd St Ste D Petersburg VA 23803-3300 | |
| (804) 653-7009 | |
| (804) 773-4688 |
| Full Name | Revive Behavioral Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 416 3rd St Ste D, Petersburg, Virginia |
| Authorized Official Name and Position | Hailey Mazzei (OWNER) |
| Authorized Official Contact | 8044903226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Behavioral Health 416 3rd St Ste D Petersburg VA 23803-3300 Ph: (804) 653-7009 | Revive Behavioral Health 416 3rd St Ste D Petersburg VA 23803-3300 Ph: (804) 653-7009 |
| NPI Number | 1942055504 |
|---|---|
| Provider Enumeration Date | 04/18/2024 |
| Last Update Date | 09/13/2025 |
| Certification Date | 09/13/2025 |
| Medicare PECOS PAC ID | 8729516125 |
|---|---|
| Medicare Enrollment ID | O20250113003787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942055504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Nakeema Patrick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316569106 PECOS PAC ID: 8022544972 Enrollment ID: I20241216001457 |
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