Provider Demographics
NPI:1033252135
Name:REYNOLDS, MARCIA LEIGH (MAE)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LEIGH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 GLEN PARK DR
Mailing Address - Street 2:# 8
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8039
Mailing Address - Country:US
Mailing Address - Phone:901-857-9502
Mailing Address - Fax:
Practice Address - Street 1:3320 BROTHER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8950
Practice Address - Country:US
Practice Address - Phone:901-251-4913
Practice Address - Fax:901-251-5003
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health