Provider Demographics
NPI:1700457488
Name:REAVES, SOPHIE K (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:K
Last Name:REAVES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 RIVER HIGHWAY
Mailing Address - Street 2:PMB 1072
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9286
Mailing Address - Country:US
Mailing Address - Phone:828-838-9322
Mailing Address - Fax:
Practice Address - Street 1:3305 16TH AVE SE STE 207A
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9213
Practice Address - Country:US
Practice Address - Phone:828-380-5839
Practice Address - Fax:704-973-7865
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16737101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional