Healthcare Provider Details

I. General information

NPI: 1366347338
Provider Name (Legal Business Name): KRISTOPHER JUNE REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 OAKWOOD ST NW
ROME GA
30165-1632
US

IV. Provider business mailing address

202 OAKWOOD ST NW
ROME GA
30165-1632
US

V. Phone/Fax

Practice location:
  • Phone: 706-506-0811
  • Fax:
Mailing address:
  • Phone: 706-506-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC006774
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: