Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2086 | NC |
N | 103T00000X | Psychologist | 2086 | NC |
N | 103G00000X | Clinical Psychologist | 2086 | ND |
N | 103TC0700X | Clinical Psychologist | 2086 | ND |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2086 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2086 | NC |
N | 103TP2701X | Group Psychotherapist | 2086 | NC |
NPI | 1053430470 |
---|---|
Provider Name | Ms. Kristy Lynn Reed |
First Address | Wilmington, NC 28405-3283 |
Second Address | Wilmington, NC 28403-4245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6107434 | (05) | NC |