Provider Demographics
NPI:1790319549
Name:REECE, THADDEUS REECESIRI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:REECESIRI
Last Name:REECE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 TULIP POPLAR WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8819
Mailing Address - Country:US
Mailing Address - Phone:678-472-0372
Mailing Address - Fax:
Practice Address - Street 1:771 TULIP POPLAR WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8819
Practice Address - Country:US
Practice Address - Phone:678-472-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical