Healthcare Provider Details

I. General information

NPI: 1659930394
Provider Name (Legal Business Name): DIOSSANTA REYES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 FALLS OF NEUSE RD STE D
RALEIGH NC
27615-3536
US

IV. Provider business mailing address

8410 FALLS OF NEUSE RD STE D
RALEIGH NC
27615-3536
US

V. Phone/Fax

Practice location:
  • Phone: 484-258-9215
  • Fax:
Mailing address:
  • Phone: 484-258-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001357
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21031
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: