Provider Demographics
NPI:1043788342
Name:REAVES, PRISCILLA A (LCPC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:REAVES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GATEWAY DR STE 21-22B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4268
Mailing Address - Country:US
Mailing Address - Phone:443-424-3599
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR STE 21-22B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:443-424-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional