Provider Demographics
NPI:1972049260
Name:REYNOLDS, OLIVIA L (LPCC-S, LMHC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPCC-S, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 SW 24TH PL APT 204
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1155
Mailing Address - Country:US
Mailing Address - Phone:850-333-6970
Mailing Address - Fax:
Practice Address - Street 1:6140 SW 24TH PL APT 204
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1155
Practice Address - Country:US
Practice Address - Phone:850-333-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health