Provider Demographics
NPI:1295106243
Name:REAVES, TERENCE DERRELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:DERRELL
Last Name:REAVES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 MILLERS GLEN LN
Mailing Address - Street 2:APT 204
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2363
Mailing Address - Country:US
Mailing Address - Phone:919-618-3737
Mailing Address - Fax:
Practice Address - Street 1:1510 WILLOW LAWN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-359-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040091631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical