Provider Demographics
NPI:1285834051
Name:REED, LATEASA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LATEASA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LATEASA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1599 J ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58205-6306
Mailing Address - Country:US
Mailing Address - Phone:701-747-4460
Mailing Address - Fax:
Practice Address - Street 1:1599 J ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58205
Practice Address - Country:US
Practice Address - Phone:701-747-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8387104100000X
VA09040074751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker