Provider Demographics
NPI:1366932394
Name:REENVISION COUNSELING & REIKI HEALING, LLC
Entity type:Organization
Organization Name:REENVISION COUNSELING & REIKI HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:443-254-3334
Mailing Address - Street 1:313 W LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3665
Mailing Address - Country:US
Mailing Address - Phone:410-618-1990
Mailing Address - Fax:443-433-0261
Practice Address - Street 1:313 W LONDON AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3665
Practice Address - Country:US
Practice Address - Phone:410-618-1990
Practice Address - Fax:443-433-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541078900Medicaid