| Revive And Thrive Mental Wellness | |
|
8435 Progress Dr Ste Ff Frederick MD 21701-4981 | |
| (301) 682-2047 | |
| (301) 644-3308 |
| Full Name | Revive And Thrive Mental Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 8435 Progress Dr Ste Ff, Frederick, Maryland |
| Authorized Official Name and Position | Gloria Corbin (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 3017326300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive And Thrive Mental Wellness 8435 Progress Dr Ste Ff Frederick MD 21701-4981 Ph: (301) 682-2047 | Revive And Thrive Mental Wellness 8435 Progress Dr Ste Ff Frederick MD 21701-4981 Ph: (301) 682-2047 |
| NPI Number | 1144852187 |
|---|---|
| Provider Enumeration Date | 02/07/2020 |
| Last Update Date | 03/25/2024 |
| Certification Date | 03/25/2024 |
| Medicare PECOS PAC ID | 0941630057 |
|---|---|
| Medicare Enrollment ID | O20200413002973 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144852187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Adetimbo Adediran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679922298 PECOS PAC ID: 4082902937 Enrollment ID: I20161011000053 |
| Provider Name | Dana Nearman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679180657 PECOS PAC ID: 1456771609 Enrollment ID: I20201009000536 |
| Provider Name | Kayla Potter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851968499 PECOS PAC ID: 1951707611 Enrollment ID: I20210902003431 |
| Provider Name | Francisca Obodo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174270995 PECOS PAC ID: 0648655225 Enrollment ID: I20220919000038 |
| Provider Name | Samantha Sudano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598534976 PECOS PAC ID: 6305283789 Enrollment ID: I20240320003888 |
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