Provider Demographics
NPI:1518372374
Name:REYES, MINA (LCPC)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:REYES
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 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-337-9441
Mailing Address - Fax:410-339-7169
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-337-9441
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional