Provider Demographics
NPI:1396446324
Name:REID, DAMARIS LILLIAN (ASW)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:LILLIAN
Last Name:REID
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:DAMARIS
Other - Middle Name:LILLIAN
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22425 SUNBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9741
Mailing Address - Country:US
Mailing Address - Phone:530-567-7766
Mailing Address - Fax:
Practice Address - Street 1:22425 SUNBRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-9741
Practice Address - Country:US
Practice Address - Phone:530-567-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health