Provider Demographics
NPI:1225081565
Name:REED, LAURIE P (MED, MSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:P
Last Name:REED
Suffix:
Gender:F
Credentials:MED, MSW
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:P
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1300 BAXTER ST
Mailing Address - Street 2:SUITE 265
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3053
Mailing Address - Country:US
Mailing Address - Phone:704-335-8716
Mailing Address - Fax:704-335-8717
Practice Address - Street 1:1300 BAXTER ST
Practice Address - Street 2:SUITE 265
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3053
Practice Address - Country:US
Practice Address - Phone:704-335-8716
Practice Address - Fax:704-335-8717
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60-02080Medicaid
NC036438OtherVALUE OPTIONS
NC286-3144Medicare ID - Type Unspecified