Provider Demographics
NPI:1134759491
Name:REYNOLDS, REBEKAH M (MSW, ICAADC, ARBS II)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSW, ICAADC, ARBS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 STEWART PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6933
Mailing Address - Country:US
Mailing Address - Phone:844-782-2454
Mailing Address - Fax:833-782-2329
Practice Address - Street 1:5833 STEWART PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6933
Practice Address - Country:US
Practice Address - Phone:844-782-2454
Practice Address - Fax:833-782-2329
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
GAC0305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty