Provider Demographics
NPI:1184996720
Name:REYNOLDS, SARAH LAVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LAVONNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2037
Mailing Address - Country:US
Mailing Address - Phone:270-982-9292
Mailing Address - Fax:270-982-9293
Practice Address - Street 1:1002 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2037
Practice Address - Country:US
Practice Address - Phone:270-982-9292
Practice Address - Fax:270-982-9293
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker