Provider Demographics
NPI:1588556575
Name:REYES, OLIVIA ROSE (LGPC)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ROSE
Last Name:REYES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 SKIP JACK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2567
Mailing Address - Country:US
Mailing Address - Phone:240-477-2109
Mailing Address - Fax:
Practice Address - Street 1:7420 HAYWARD RD STE 104
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2510
Practice Address - Country:US
Practice Address - Phone:240-575-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health