Provider Demographics
NPI:1356757918
Name:REID WHITESIDE, PH.D., P.C.
Entity type:Organization
Organization Name:REID WHITESIDE, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-677-8700
Mailing Address - Street 1:1616 EVANS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-677-8700
Mailing Address - Fax:919-651-1007
Practice Address - Street 1:1616 EVANS RD STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-677-8700
Practice Address - Fax:919-651-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1507103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty