Provider Demographics
NPI:1710074059
Name:SOLOMON, REGINALD J (LPC)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:J
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EMERY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-803-7678
Mailing Address - Fax:478-743-7442
Practice Address - Street 1:175 EMERY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3692
Practice Address - Country:US
Practice Address - Phone:478-751-4446
Practice Address - Fax:478-751-4444
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004292101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004292OtherLPC