Provider Demographics
NPI:1275031726
Name:REIDS WELLNESS THERAPY AND RESEARCH CENTER
Entity Type:Organization
Organization Name:REIDS WELLNESS THERAPY AND RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-344-0857
Mailing Address - Street 1:3900 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4202
Mailing Address - Country:US
Mailing Address - Phone:804-264-2963
Mailing Address - Fax:
Practice Address - Street 1:3900 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4202
Practice Address - Country:US
Practice Address - Phone:804-264-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty