Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2199 | NC |
Y | 103T00000X | Psychologist | 2199 | NC |
NPI | 1013232669 |
---|---|
Provider Name | Dr. Benjamin David Reese JR. |
First Address | Raleigh, NC 27615-1659 |
Second Address | Raleigh, NC 27615-3099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2010 |
Last Update Date | 06/04/2010 |