Provider Demographics
NPI:1194909408
Name:REINHARDT, ROBERT ANTHONY (MED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NEW MOON CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5385
Mailing Address - Country:US
Mailing Address - Phone:919-414-7712
Mailing Address - Fax:888-360-8640
Practice Address - Street 1:602 E ACADEMY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2382
Practice Address - Country:US
Practice Address - Phone:919-414-7712
Practice Address - Fax:888-360-8640
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103853Medicaid