Provider Demographics
NPI:1194013037
Name:REYNOLDS, THOMAS WAYNE (CADC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WAYNE
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DELTA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4745
Mailing Address - Country:US
Mailing Address - Phone:207-856-7227
Mailing Address - Fax:207-856-2112
Practice Address - Street 1:1 DELTA DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4745
Practice Address - Country:US
Practice Address - Phone:207-856-7227
Practice Address - Fax:207-856-2112
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4236101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)