Provider Demographics
NPI:1932511169
Name:REYNOLDS, SHARNIQUA
Entity Type:Individual
Prefix:
First Name:SHARNIQUA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 TOWER DR
Mailing Address - Street 2:APT #3
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1552
Mailing Address - Country:US
Mailing Address - Phone:347-496-2304
Mailing Address - Fax:
Practice Address - Street 1:3244 TOWER DR
Practice Address - Street 2:APT #3
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1552
Practice Address - Country:US
Practice Address - Phone:347-496-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health