# MENTAL HEALTH PRO PA REVIVED WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366310112
- **Authorized official:** VICTORIA ENEYI ABOLARIN (OWNER OF ENTITY)
- **Authorized official phone:** (818) 300-9424

## Contact information

- **Practice address:** 4400 S PIEDRAS DR STE 217, SAN ANTONIO, TX 78228-1223
- **Practice address phone:** (210) 903-3383
- **Mailing address:** 7475 CALLAGHAN RD, SAN ANTONIO, TX 78229-2969
- **Mailing address phone:** (210) 903-3383
- **Mailing address fax:** (210) 544-5194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/24/2025
- **Last updated:** 03/05/2026