Provider Demographics
NPI:1578079166
Name:REYNOLDS, ANDREA (MA, LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, LCMHC, LADC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:PALKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 DION ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1517
Mailing Address - Country:US
Mailing Address - Phone:518-221-7227
Mailing Address - Fax:
Practice Address - Street 1:108 DION ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404
Practice Address - Country:US
Practice Address - Phone:518-221-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0117987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health