Provider Demographics
NPI:1770775785
Name:REID, TIMOTHY C (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:REID
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2727
Mailing Address - Country:US
Mailing Address - Phone:228-326-0787
Mailing Address - Fax:228-331-0204
Practice Address - Street 1:4494 POPPS FERRY RD STE C
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2468
Practice Address - Country:US
Practice Address - Phone:228-273-5773
Practice Address - Fax:228-331-0204
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC73601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03981714Medicaid