Healthcare Provider Details

I. General information

NPI: 1104774660
Provider Name (Legal Business Name): FELICIA RESHEA REIVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 RAVENHURST CIR APT 102
SPRING LAKE NC
28390-3282
US

IV. Provider business mailing address

654 RAVENHURST CIR APT 102
SPRING LAKE NC
28390-3282
US

V. Phone/Fax

Practice location:
  • Phone: 919-770-6574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: