Provider Demographics
NPI:1528237369
Name:REEVES, SIMONE STEPHENS (MA,LPC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:STEPHENS
Last Name:REEVES
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3088
Mailing Address - Country:US
Mailing Address - Phone:704-840-2848
Mailing Address - Fax:
Practice Address - Street 1:11709 FRUEHAUF DR STE 225
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-0043
Practice Address - Country:US
Practice Address - Phone:704-840-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7160101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104316Medicaid