Provider Demographics
NPI:1245603976
Name:REYNOLDS, ROBIN (MA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HEARTHSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6145
Mailing Address - Country:US
Mailing Address - Phone:843-450-2391
Mailing Address - Fax:
Practice Address - Street 1:207 HEARTHSTONE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6145
Practice Address - Country:US
Practice Address - Phone:843-450-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)