Provider Demographics
NPI:1174745012
Name:REEVES, SALLY G (MA)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:G
Last Name:REEVES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CHERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9109
Mailing Address - Country:US
Mailing Address - Phone:336-846-5348
Mailing Address - Fax:
Practice Address - Street 1:176 WILDCAT ROAD
Practice Address - Street 2:
Practice Address - City:DEEP GAP
Practice Address - State:NC
Practice Address - Zip Code:28618-9267
Practice Address - Country:US
Practice Address - Phone:828-262-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist