Healthcare Provider Details

I. General information

NPI: 1760193528
Provider Name (Legal Business Name): ARACELI REYES MASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 AIRPORT DR
MONCKS CORNER SC
29461-2629
US

IV. Provider business mailing address

306 AIRPORT DR
MONCKS CORNER SC
29461-2629
US

V. Phone/Fax

Practice location:
  • Phone: 843-719-3000
  • Fax:
Mailing address:
  • Phone: 843-719-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: