Organization
REVIVE LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RADHIKA NATARAJ (AUTHORIZED OFFICIAL)
(301) 252-1866
Entity
Organization
Contact information
Practice address
316 E DIAMOND AVE, GAITHERSBURG, MD 20877-3070
(206) 898-5432
Mailing address
316 E DIAMOND AVE, GAITHERSBURG, MD 20877-3070
(301) 252-1866
(301) 345-3516
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/21/2025
Last updated
03/25/2026
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