Provider Demographics
NPI:1568806651
Name:REYNOLDS, WILLIAM T JR (MAMFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:REYNOLDS
Suffix:JR
Gender:M
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 ALLISON COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4971
Mailing Address - Country:US
Mailing Address - Phone:843-259-0591
Mailing Address - Fax:843-769-7288
Practice Address - Street 1:896 KUSHIWAH CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4410
Practice Address - Country:US
Practice Address - Phone:843-259-0591
Practice Address - Fax:843-769-7288
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist