| Shawtay Reese | |
|
108 S Bragg St Ste 3 Warrenton NC 27589-2048 | |
| (252) 204-2188 | |
| Not Available |
| Full Name | Shawtay Reese |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 108 S Bragg St Ste 3, Warrenton, North Carolina |
| Authorized Official Name and Position | Shawtay Reese (CEO) |
| Authorized Official Contact | 9195592692 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawtay Reese 3811 Chehaw Dr Raleigh NC 27610-6482 Ph: (919) 559-2692 | Shawtay Reese 108 S Bragg St Ste 3 Warrenton NC 27589-2048 Ph: (252) 204-2188 |
| NPI Number | 1396308920 |
|---|---|
| Provider Enumeration Date | 04/18/2019 |
| Last Update Date | 06/10/2024 |
| Certification Date | 03/21/2024 |
| Medicare PECOS PAC ID | 5698101087 |
|---|---|
| Medicare Enrollment ID | O20200203001944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396308920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Shawtay Devonne Reese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245674605 PECOS PAC ID: 2961710637 Enrollment ID: I20150929002270 |
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