Provider Demographics
NPI:1205495744
Name:REESE, BIONCA (MSW)
Entity type:Individual
Prefix:
First Name:BIONCA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 CEDAR HURST TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4521
Mailing Address - Country:US
Mailing Address - Phone:678-755-7484
Mailing Address - Fax:
Practice Address - Street 1:3040 HOLCOMB BRIDGE RD STE J2
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1357
Practice Address - Country:US
Practice Address - Phone:678-755-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty