Individual
EARNEST RUSSELL REAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
3109 EBBTIDE DR, EDGEWOOD, MD 21040-2920
(443) 691-4982
Mailing address
3109 EBBTIDE DR, EDGEWOOD, MD 21040-2920
(443) 691-4982
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC8273
MD
Other
Enumeration date
11/18/2017
Last updated
11/18/2017
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