Organization
ASE' REVIVAL TELEPSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TIPHANIE MICHELE JONES PMHNP-BC (CEO/ PMHNP-BC)
(804) 933-1463
Entity
Organization
Contact information
Practice address
4410 EAST CLAIBORNE SQUARE, SUITE 334,, HAMPTON, VA 23666
(804) 933-1463
(757) 520-4668
Mailing address
110 COLISEUM XING # 5228, HAMPTON, VA 23666-5971
(804) 933-1463
(757) 520-4668
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2025
Last updated
10/09/2025
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