Provider Demographics
NPI:1811089618
Name:REYNOLDS, DAVID JERMOE (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JERMOE
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DELAWARE AVE SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4207
Mailing Address - Country:US
Mailing Address - Phone:202-697-3227
Mailing Address - Fax:
Practice Address - Street 1:815 DELAWARE AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4207
Practice Address - Country:US
Practice Address - Phone:202-697-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1183103T00000X
CO2798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist