Provider Demographics
NPI:1982769006
Name:REESE, LE'ROY E (PHD)
Entity Type:Individual
Prefix:
First Name:LE'ROY
Middle Name:E
Last Name:REESE
Suffix:
Gender:M
Credentials: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 832152
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-0036
Mailing Address - Country:US
Mailing Address - Phone:404-378-7309
Mailing Address - Fax:404-378-7310
Practice Address - Street 1:103 N MCDONOUGH ST
Practice Address - Street 2:REAR UNIT
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3317
Practice Address - Country:US
Practice Address - Phone:404-378-7309
Practice Address - Fax:404-378-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical