Provider Demographics
NPI:1053669291
Name:REYNOLDS, LATONJA (LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:LATONJA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 COTTON TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2833
Mailing Address - Country:US
Mailing Address - Phone:334-312-6435
Mailing Address - Fax:
Practice Address - Street 1:1826 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1516
Practice Address - Country:US
Practice Address - Phone:334-312-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional