Organization
EDWIN REISFELD PHD PA
Active
Other names
Eastside Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN H REISFELD PHD (OWNER/PSYCHOLOGIST)
(704) 927-5881
Entity
Organization
Contact information
Practice address
15720 JOHN J DELANEY DR, SUITE 300, CHARLOTTE, NC 28277-3430
(704) 927-5881
(704) 944-3201
Mailing address
52511 WINCHESTER STREET, FORT MILL, SC 29707
(704) 927-5881
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3748
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2826004
MEDICARE PTAN
NC
01
—
2826004A
MEDICARE INDIVIDUAL
NC
Enumeration date
05/09/2007
Last updated
08/22/2011
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