Provider Demographics
NPI:1730310616
Name:REAVES, VICTORIA TIGNER (LPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:TIGNER
Last Name:REAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 OAK GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-7735
Mailing Address - Country:US
Mailing Address - Phone:770-328-4829
Mailing Address - Fax:770-832-9351
Practice Address - Street 1:2404 REFUGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4946
Practice Address - Country:US
Practice Address - Phone:706-692-7209
Practice Address - Fax:706-692-0144
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001671101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health