Provider Demographics
NPI:1518602069
Name:REYNOLDS, LAURA (CDCA186703)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CDCA186703
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4035
Mailing Address - Country:US
Mailing Address - Phone:614-888-2233
Mailing Address - Fax:
Practice Address - Street 1:3197 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4035
Practice Address - Country:US
Practice Address - Phone:614-568-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.186703101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)