Provider Demographics
NPI:1427664101
Name:REYES, CARLOS (CACII1087)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:CACII1087
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 INDIANA AVE NW STE 1230
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2131
Mailing Address - Country:US
Mailing Address - Phone:202-879-1620
Mailing Address - Fax:202-879-1618
Practice Address - Street 1:500 INDIANA AVE NW STE 1230
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2131
Practice Address - Country:US
Practice Address - Phone:202-879-1620
Practice Address - Fax:202-879-1618
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1087101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)