Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY002761 | GA |
NPI | 1073807608 |
---|---|
Provider Name | Dr. Alaycia Deneen Reid |
First Address | Decatur, GA 30030-2400 |
Second Address | Decatur, GA 30030-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |