Provider Demographics
NPI:1982857991
Name:REYNOLDS, WENDIE BRANNEN (LCSW, ACSW, MA)
Entity Type:Individual
Prefix:
First Name:WENDIE
Middle Name:BRANNEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW, ACSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:478-742-1464
Mailing Address - Fax:478-742-1883
Practice Address - Street 1:179 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2821
Practice Address - Country:US
Practice Address - Phone:478-742-1464
Practice Address - Fax:478-742-1883
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical