=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366932394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REENVISION COUNSELING & REIKI HEALING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W LONDON AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-618-1990
-----------------------------------------------------
Fax | 443-433-0261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 W LONDON AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-618-1990
-----------------------------------------------------
Fax | 443-433-0261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAM LYNN FUSCO
-----------------------------------------------------
Credential | LPC, LCADC
-----------------------------------------------------
Telephone | 443-254-3334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------