Provider Demographics
NPI:1013216043
Name:REYNOLDS PRINCE, MARGARET LOUISE (ED D)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:LOUISE
Last Name:REYNOLDS PRINCE
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:LOUISE
Other - Last Name:REYNOLDS PRINCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ED D
Mailing Address - Street 1:212 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3819
Mailing Address - Country:US
Mailing Address - Phone:727-828-8362
Mailing Address - Fax:727-823-8082
Practice Address - Street 1:275 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3205
Practice Address - Country:US
Practice Address - Phone:727-828-8362
Practice Address - Fax:727-823-8082
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health