Provider Demographics
NPI:1881790947
Name:VAN REEDE, GODARD JACQUES (PHD)
Entity type:Individual
Prefix:DR
First Name:GODARD
Middle Name:JACQUES
Last Name:VAN REEDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2245 STANTONSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2868
Mailing Address - Country:US
Mailing Address - Phone:252-752-0483
Mailing Address - Fax:252-752-2971
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:SUITE O
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-638-3742
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical