Provider Demographics
NPI:1760256895
Name:REEVES, STEPHANIE A (LCSWA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 RICHELIEU RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7934
Mailing Address - Country:US
Mailing Address - Phone:919-394-5443
Mailing Address - Fax:
Practice Address - Street 1:10 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4217
Practice Address - Country:US
Practice Address - Phone:910-755-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0165711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical