Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1000000020948 | TN |
NPI | 1033629209 |
---|---|
Provider Name | Rebecca J Reed |
First Address | Jackson, TN 38301-9109 |
Second Address | Jackson, TN 38301-9160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |