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General NPI Number Information
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NPI Number | 1770775785
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Entity Type | Individual
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Provider Name | TIMOTHY C REID LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 4494 POPPS FERRY RD STE C
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City | DIBERVILLE
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State | MS
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Zip | 39540-2468
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Country | US
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Telephone | 228-273-5773
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Fax | 228-331-0204
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Provider Business Mailing Address
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Address Line | 16020 FRANKLIN DR
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City | BILOXI
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State | MS
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Zip | 39532-2727
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Country | US
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Telephone | 228-326-0787
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Fax | 228-331-0204
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C7360
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License Number State | MS
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