Provider Demographics
NPI:1225445208
Name:RAINEY-REED, WANDA MARCELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:MARCELLA
Last Name:RAINEY-REED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 KLONDIKE RD SW STE D
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5128
Mailing Address - Country:US
Mailing Address - Phone:770-679-4336
Mailing Address - Fax:888-700-6924
Practice Address - Street 1:1453 KLONDIKE RD SW STE D
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:770-679-4336
Practice Address - Fax:888-700-6924
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1810101YA0400X
GACSW0051311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)