Healthcare Provider Details

I. General information

NPI: 1114872116
Provider Name (Legal Business Name): WANDA REEVES CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 PARKWAY AVE
EWING NJ
08628-3018
US

IV. Provider business mailing address

1230 PARKWAY AVE
EWING NJ
08628-3018
US

V. Phone/Fax

Practice location:
  • Phone: 609-337-2973
  • Fax: 609-393-1246
Mailing address:
  • Phone: 609-337-2973
  • Fax: 609-393-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00202900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: