Healthcare Provider Details

I. General information

NPI: 1992632368
Provider Name (Legal Business Name): CRYSTAL MONAE REESE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 ASHLEY CROSSING DR
CHARLESTON SC
29414-5700
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105 PMB 995171
NORTH CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax:
Mailing address:
  • Phone: 843-475-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number31946
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: