Provider Demographics
NPI:1073028288
Name:REYNOLDS, RITA
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:
Last Name:REYNOLDS
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:PO BOX 8189
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-0189
Mailing Address - Country:US
Mailing Address - Phone:330-867-5400
Mailing Address - Fax:330-996-4959
Practice Address - Street 1:1221 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3805
Practice Address - Country:US
Practice Address - Phone:234-708-4184
Practice Address - Fax:330-869-8263
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.166501101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)