Provider Demographics
NPI:1194346577
Name:REEVES, GWENDOLYN (LCMHC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:REEVES
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 1:214 EDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8021
Mailing Address - Country:US
Mailing Address - Phone:828-317-1546
Mailing Address - Fax:
Practice Address - Street 1:54 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-8728
Practice Address - Country:US
Practice Address - Phone:828-652-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health