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General NPI Number Information
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NPI Number | 1659551919
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Entity Type | Organization
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Legal Business Name | ORLIE REID JR
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2940 MERCHANT CT
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City | WALDORF
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State | MD
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Zip | 20603-5302
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Country | US
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Telephone | 240-461-3255
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Fax | 301-705-8944
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Provider Business Mailing Address
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Address Line | 2940 MERCHANT CT
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City | WALDORF
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State | MD
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Zip | 20603-5302
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Country | US
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Telephone | 240-461-3255
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Fax | 301-705-8944
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Authorized Official
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Title or Position | CEO
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Name | MR. ORLIE WHEATLY REID JR.
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Credential | LCSW-C, LICSW
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Telephone | 240-461-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12188
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License Number State | MD
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