Healthcare Provider Details

I. General information

NPI: 1679021604
Provider Name (Legal Business Name): ROBIN THERESA REESE MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 S 11TH ST UNIT 3
PHILADELPHIA PA
19147-4627
US

IV. Provider business mailing address

1182 S 11TH ST UNIT 3
PHILADELPHIA PA
19147-4627
US

V. Phone/Fax

Practice location:
  • Phone: 703-307-6015
  • Fax:
Mailing address:
  • Phone: 703-307-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009090
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006524
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPPS-0604969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: