Provider Demographics
NPI:1811085673
Name:REED, MICHAEL LEWIS (EDD PHD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:REED
Suffix:
Gender:M
Credentials:EDD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28563
Mailing Address - Country:US
Mailing Address - Phone:252-638-3881
Mailing Address - Fax:252-638-8820
Practice Address - Street 1:504 POLLOCK ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28563
Practice Address - Country:US
Practice Address - Phone:252-638-3881
Practice Address - Fax:252-638-8820
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000170Medicaid
NC0245ROtherBCBS
NC6000170Medicaid