Provider Demographics
NPI:1538538285
Name:REESE FAMILY SERVICES
Entity type:Organization
Organization Name:REESE FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-435-5297
Mailing Address - Street 1:331 BEXLEY PARK WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608
Mailing Address - Country:US
Mailing Address - Phone:757-435-5297
Mailing Address - Fax:757-594-0028
Practice Address - Street 1:714 J CLYDE MORRIS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1535
Practice Address - Country:US
Practice Address - Phone:757-435-5297
Practice Address - Fax:757-594-0028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REESE FAMILY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2207320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316361736Medicaid