Provider Demographics
NPI:1518600733
Name:REESE, ELIZABETH ANNE (SUDP WA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:REESE
Suffix:
Gender:F
Credentials:SUDP WA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11734 LAKE ASTON CT APT 214
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 CAPRI DRIVE
Practice Address - Street 2:
Practice Address - City:WEST PORTERS LAKE
Practice Address - State:NOVA SCOTIA
Practice Address - Zip Code:B3E 1L6
Practice Address - Country:CA
Practice Address - Phone:206-735-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60896266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)