Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 BALTIMORE ANNAPOLIS BLVD STE 312
SEVERNA PARK MD
21146-4716
US

IV. Provider business mailing address

877 BALTIMORE ANNAPOLIS BLVD STE 312
SEVERNA PARK MD
21146-4716
US

V. Phone/Fax

Practice location:
  • Phone: 410-315-9350
  • Fax: 833-449-5169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: