Provider Demographics
NPI:1679021604
Name:REESE, ROBIN THERESA (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:THERESA
Last Name:REESE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 S 11TH ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4627
Mailing Address - Country:US
Mailing Address - Phone:703-307-6015
Mailing Address - Fax:
Practice Address - Street 1:1182 S 11TH ST
Practice Address - Street 2:UNIT 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4627
Practice Address - Country:US
Practice Address - Phone:703-307-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009090101YP2500X
VA0701006524101YP2500X
VAPPS-0604969101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool