Provider Demographics
NPI:1093978397
Name:REIVES, CYNTHIA TAYLOR (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:TAYLOR
Last Name:REIVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2041
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-2041
Mailing Address - Country:US
Mailing Address - Phone:919-774-3399
Mailing Address - Fax:919-774-3401
Practice Address - Street 1:900 S VANCE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4774
Practice Address - Country:US
Practice Address - Phone:919-774-3399
Practice Address - Fax:919-774-3401
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104085Medicaid