Provider Demographics
NPI:1356831887
Name:REYNOLDS, CORIE PRESTON (EDS)
Entity Type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:PRESTON
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 DUET RD
Mailing Address - Street 2:
Mailing Address - City:ETLAN
Mailing Address - State:VA
Mailing Address - Zip Code:22719-2038
Mailing Address - Country:US
Mailing Address - Phone:540-923-4724
Mailing Address - Fax:
Practice Address - Street 1:254 MONROE DR
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-2852
Practice Address - Country:US
Practice Address - Phone:434-939-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000025103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool