Provider Demographics
NPI:1679248652
Name:RICHALE R REED PLLC
Entity Type:Organization
Organization Name:RICHALE R REED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHALE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHCS, LCAS
Authorized Official - Phone:880-550-2804
Mailing Address - Street 1:1930 CLUB POND RD # 1015
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8691
Mailing Address - Country:US
Mailing Address - Phone:888-550-2804
Mailing Address - Fax:
Practice Address - Street 1:1930 CLUB POND RD # 1015
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8691
Practice Address - Country:US
Practice Address - Phone:888-550-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356660344Medicaid