CLIA lab
CLIA 49D2269697: Revival Wellness and Ketamine
Chantilly, VA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 49D2269697 belongs to Revival Wellness and Ketamine in Chantilly, VA.
Certificate of Waiver, effective September 30, 2024, expiration date September 29, 2026.
The CMS file posted October 16, 2026 lists the certificate as active, but its expiration date has passed. A renewal may not be in this file yet.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- September 30, 2024
- Certificate expiration
- September 29, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 30, 2022
- Facility type
- Other
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 49D2269697
- Lab name
- Revival Wellness and Ketamine
- Address
- 4200-B Technology Court, Chantilly, VA 20151
- Phone
- (703) 988-3984
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Revival Wellness and Ketamine in Chantilly?
49D2269697, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Revival Wellness and Ketamine hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 49D2269697 expire?
The CMS file lists September 29, 2026 as the certificate expiration date; the certificate took effect September 30, 2024.