Provider Demographics
NPI:1265920763
Name:REID, MANUELA LATOYA (LCSW)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:LATOYA
Last Name:REID
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAN
Other - Middle Name:REID
Other - Last Name:DA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5604 WILLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1417
Mailing Address - Country:US
Mailing Address - Phone:205-901-6071
Mailing Address - Fax:
Practice Address - Street 1:6210 N JONES BLVD UNIT 751383
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89136-8869
Practice Address - Country:US
Practice Address - Phone:702-408-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7848C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical