Provider Demographics
NPI:1417402363
Name:REEVES, ERICA
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GLENLOCH RD
Mailing Address - Street 2:
Mailing Address - City:ROOPVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30170-2527
Mailing Address - Country:US
Mailing Address - Phone:770-856-1521
Mailing Address - Fax:
Practice Address - Street 1:175 GLENLOCH RD
Practice Address - Street 2:
Practice Address - City:ROOPVILLE
Practice Address - State:GA
Practice Address - Zip Code:30170-2527
Practice Address - Country:US
Practice Address - Phone:770-856-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005497101YP2500X
GALPC12301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional