Provider Demographics
NPI:1861231953
Name:REID, BREANA JENAL
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:JENAL
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 1:500 SINGLETON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:910-338-8520
Mailing Address - Fax:
Practice Address - Street 1:500 SINGLETON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4478
Practice Address - Country:US
Practice Address - Phone:910-338-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health