Healthcare Provider Details

I. General information

NPI: 1538639992
Provider Name (Legal Business Name): SHANEETA D REAVES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8638 VETERANS HWY STE 301
MILLERSVILLE MD
21108-1422
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 209
COLUMBIA MD
21044-6278
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax:
Mailing address:
  • Phone: 410-740-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9305
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP7646
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: