Provider Demographics
NPI:1306669452
Name:REID, CHARISSA QWINDELL
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:QWINDELL
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 ARID AVE APT 2074
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0793
Mailing Address - Country:US
Mailing Address - Phone:702-945-8393
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 23
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1933
Practice Address - Country:US
Practice Address - Phone:702-602-5103
Practice Address - Fax:725-302-2406
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician