Provider Demographics
NPI:1457066250
Name:RESET MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:RESET MENTAL HEALTH PLLC
Other - Org Name:ELLIE MENTAL HEALTH PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:EADES
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, LCSW
Authorized Official - Phone:910-264-9779
Mailing Address - Street 1:620 SUMMIT CROSSING PL STE 305
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 SUMMIT CROSSING PL STE 305
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2176
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty