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General NPI Number Information
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NPI Number | 1902010804
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Entity Type | Organization
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Legal Business Name | EDWIN REISFELD PHD PA
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 15720 JOHN J DELANEY DR SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-3430
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Country | US
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Telephone | 704-927-5881
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Fax | 704-944-3201
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Provider Business Mailing Address
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Address Line | 52511 WINCHESTER STREET
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City | FORT MILL
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State | SC
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Zip | 29707
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Country | US
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Telephone | 704-927-5881
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. EDWIN H REISFELD
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Credential | PHD
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Telephone | 704-927-5881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3748
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License Number State | NC
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