=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235611492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELIA GISELLE REEVES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 02/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 PALMER RD STE B4
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-3185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-286-0688
-----------------------------------------------------
Fax | 256-474-0506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12557 JESSE LN
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35613-8440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-303-2290
-----------------------------------------------------
Fax | 256-474-0506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC04377
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------