Healthcare Provider Details

I. General information

NPI: 1093632283
Provider Name (Legal Business Name): LATOYA REESE LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GERVAIS ST UNIT 2B
COLUMBIA SC
29201-3125
US

IV. Provider business mailing address

801 GERVAIS ST UNIT 2B
COLUMBIA SC
29201-3125
US

V. Phone/Fax

Practice location:
  • Phone: 803-888-6714
  • Fax:
Mailing address:
  • Phone: 803-888-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10166
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: