Provider Demographics
NPI:1659401479
Name:REILLY, TAMARA EVE (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:EVE
Last Name:REILLY
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 ESTHWAITE DR SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-3407
Mailing Address - Country:US
Mailing Address - Phone:336-549-3099
Mailing Address - Fax:336-609-6324
Practice Address - Street 1:559 ESTHWAITE DR SE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-3407
Practice Address - Country:US
Practice Address - Phone:336-549-3099
Practice Address - Fax:336-609-6324
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist