Provider Demographics
NPI:1205349388
Name:REID, KAITLIN
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 POINSETT PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29168-9440
Mailing Address - Country:US
Mailing Address - Phone:864-903-5196
Mailing Address - Fax:
Practice Address - Street 1:3115 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3425
Practice Address - Country:US
Practice Address - Phone:803-791-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician