Provider Demographics
NPI:1477247617
Name:REID, LORA HILDRETH (MA, LPA, HSP)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:HILDRETH
Last Name:REID
Suffix:
Gender:F
Credentials:MA, LPA, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 PIEDMONT PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8174
Mailing Address - Country:US
Mailing Address - Phone:336-855-4649
Mailing Address - Fax:
Practice Address - Street 1:4160 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8174
Practice Address - Country:US
Practice Address - Phone:336-855-4649
Practice Address - Fax:336-261-6488
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2096103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty