Provider Demographics
NPI:1093902306
Name:REYNOLDS-NEU, SASHA RAE (LICSW)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:RAE
Last Name:REYNOLDS-NEU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:RAE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3686 SIMPSON POINT RD
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35747-7913
Mailing Address - Country:US
Mailing Address - Phone:205-420-1742
Mailing Address - Fax:256-427-2350
Practice Address - Street 1:917 WILLOWBROOK DR SE # F3
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3263
Practice Address - Country:US
Practice Address - Phone:205-420-1742
Practice Address - Fax:256-427-2350
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1436C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51548405OtherBCBS
AL51548405OtherBCBS