MEDICARE: REINA ELIZABETH AREVALO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LGP12863	OTHER	MD	LGPC

General Provider Information

NPI Number	:	1831822568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REINA ELIZABETH AREVALO

Provider Business Mailing Address
First Line	:	1300 MERCANTILE LN STE 134B
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5332
Country	:	US
Telephone Number	:	202-836-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 MERCANTILE LN STE 134B
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5332
Country	:	US
Telephone Number	:	202-836-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2022
Last Update Date	:	04/27/2024

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Directions to “ REINA ELIZABETH AREVALO ” Practice Location

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