Provider Demographics
NPI:1437533668
Name:MCREYNOLDS, JACQUELINE I
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MCREYNOLDS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 1/2 RHODE ISLAND AVE, NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-506-4658
Mailing Address - Fax:202-506-4860
Practice Address - Street 1:607 1/2 RHODE ISLAND AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1854
Practice Address - Country:US
Practice Address - Phone:202-506-4658
Practice Address - Fax:202-506-4860
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
DC66005684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)