Provider Demographics
NPI:1073387296
Name:REYNOLDS, ASIA EVELYN LEE (N/A)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:EVELYN LEE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 EL SEGUNDA LN
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4900
Mailing Address - Country:US
Mailing Address - Phone:240-587-8129
Mailing Address - Fax:
Practice Address - Street 1:1517 REISTERSTOWN RD STE 211
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4325
Practice Address - Country:US
Practice Address - Phone:410-541-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician