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General NPI Number Information
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NPI Number | 1659401479
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Entity Type | Individual
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Provider Name | TAMARA EVE REILLY PSY.D., M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 559 ESTHWAITE DR SE
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City | LELAND
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State | NC
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Zip | 28451-3407
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Country | US
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Telephone | 336-549-3099
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Fax | 336-609-6324
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Provider Business Mailing Address
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Address Line | 559 ESTHWAITE DR SE
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City | LELAND
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State | NC
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Zip | 28451-3407
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Country | US
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Telephone | 336-549-3099
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Fax | 336-609-6324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1482
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License Number State | NC
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