# ASE' REVIVAL TELEPSYCHIATRY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1588539449
- **Authorized official:** MISS TIPHANIE MICHELE JONES PMHNP-BC (CEO/ PMHNP-BC)
- **Authorized official phone:** (804) 933-1463

## Contact information

- **Practice address:** 4410 EAST CLAIBORNE SQUARE, SUITE 334,, HAMPTON, VA 23666
- **Practice address phone:** (804) 933-1463
- **Practice address fax:** (757) 520-4668
- **Mailing address:** 110 COLISEUM XING \# 5228, HAMPTON, VA 23666-5971
- **Mailing address phone:** (804) 933-1463
- **Mailing address fax:** (757) 520-4668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2025
- **Last updated:** 10/09/2025