Healthcare Provider Details

I. General information

NPI: 1124794383
Provider Name (Legal Business Name): NICOLE CHRISTINE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 WESTWOOD AVE
RICHMOND VA
23230-4011
US

IV. Provider business mailing address

2311 WESTWOOD AVE
RICHMOND VA
23230-4011
US

V. Phone/Fax

Practice location:
  • Phone: 301-800-8696
  • Fax:
Mailing address:
  • Phone: 301-800-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: