Provider Demographics
NPI:1407195027
Name:REYLE, JOAN (MA, CACI)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:REYLE
Suffix:
Gender:F
Credentials:MA, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6000
Mailing Address - Fax:843-255-9406
Practice Address - Street 1:1905 DUKE ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4403
Practice Address - Country:US
Practice Address - Phone:843-255-6000
Practice Address - Fax:843-255-9406
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1205305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)