Provider Demographics
NPI:1568696201
Name:REYNOLDS, CARA L (LISW - SUPV)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LISW - SUPV
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:L
Other - Last Name:PELLIGREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:146-388-7296
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-388-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-10
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0008223-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical