Provider Demographics
NPI:1598932352
Name:REYNOLDS, CARMEN JOHNSON (MA ED LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:JOHNSON
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA ED LPC
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA ED LPC
Mailing Address - Street 1:11 YESTER OAKS CIR APT J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3121
Mailing Address - Country:US
Mailing Address - Phone:336-327-8602
Mailing Address - Fax:
Practice Address - Street 1:11 YESTER OAKS CIR APT J
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3121
Practice Address - Country:US
Practice Address - Phone:336-327-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4134LPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor