Basic Information
| Provider Information | |||||||||
| NPI: | 1841715356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REFLECTIVE EYES COUNSELING AND CONSULTING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7505 NEW HAMPSHIRE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209126972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108045865 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7505 NEW HAMPSHIRE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209126972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108045865 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | ANIELKA | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 5108045865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPCP | ||||||||
| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCPC6269 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.