Provider Demographics
NPI:1528401775
Name:REYNOLDS, MARGIE MAE (LPCC)
Entity Type:Individual
Prefix:DR
First Name:MARGIE
Middle Name:MAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NEW START RD
Mailing Address - Street 2:
Mailing Address - City:BRONSTON
Mailing Address - State:KY
Mailing Address - Zip Code:42518-8572
Mailing Address - Country:US
Mailing Address - Phone:606-561-5797
Mailing Address - Fax:606-561-9928
Practice Address - Street 1:500 NEW START RD
Practice Address - Street 2:
Practice Address - City:BRONSTON
Practice Address - State:KY
Practice Address - Zip Code:42518-8572
Practice Address - Country:US
Practice Address - Phone:606-561-5797
Practice Address - Fax:606-561-9928
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional