Provider Demographics
NPI:1114435211
Name:REYNOLDS, RENEE JEANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:JEANNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3109 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2956
Mailing Address - Country:US
Mailing Address - Phone:703-304-5439
Mailing Address - Fax:804-520-4342
Practice Address - Street 1:3451 CONDUIT RD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2625
Practice Address - Country:US
Practice Address - Phone:804-524-3405
Practice Address - Fax:804-520-4342
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040100711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical