Provider Demographics
NPI:1831822568
Name:AREVALO, REINA ELIZABETH
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:ELIZABETH
Last Name:AREVALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MERCANTILE LN STE 134B
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5332
Mailing Address - Country:US
Mailing Address - Phone:202-836-7178
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 134B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5332
Practice Address - Country:US
Practice Address - Phone:202-836-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP12863OtherLGPC