Provider Demographics
NPI:1518317916
Name:REYNOLDS, CHRISTINA MICHELLE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:RUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2805 W GOVERNOR JOHN SEVIER HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5552
Mailing Address - Country:US
Mailing Address - Phone:865-298-3558
Mailing Address - Fax:
Practice Address - Street 1:2805 W GOVERNOR JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5552
Practice Address - Country:US
Practice Address - Phone:865-298-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)