Provider Demographics
NPI:1588777296
Name:REEVES, MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:REEVES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 REGIMENT LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-5783
Mailing Address - Country:US
Mailing Address - Phone:540-361-1216
Mailing Address - Fax:540-373-6266
Practice Address - Street 1:406 CHATHAM SQUARE
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22403
Practice Address - Country:US
Practice Address - Phone:540-373-9577
Practice Address - Fax:540-373-6266
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040053761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA373218OtherMHN
VA490906OtherVALUE OPTIONS
VA3857OtherCAREFIRST BC/BS
VA9422100OtherPHCS
VA189443OtherANTHEM BC/BS
VA11527184OtherCAQH
VA7139727OtherAETNA