Provider Demographics
NPI:1134313166
Name:REID, ORLIE WHEATLY JR (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ORLIE
Middle Name:WHEATLY
Last Name:REID
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 MERCHANT CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5302
Mailing Address - Country:US
Mailing Address - Phone:240-462-3255
Mailing Address - Fax:310-705-8944
Practice Address - Street 1:2940 MERCHANT CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5302
Practice Address - Country:US
Practice Address - Phone:240-462-3255
Practice Address - Fax:310-705-8944
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical