Provider Demographics
NPI:1881244812
Name:ANDREA REYNOLDS, LCMHC, LADC, LLC
Entity type:Organization
Organization Name:ANDREA REYNOLDS, LCMHC, LADC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCMHC, LADC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-777-9727
Mailing Address - Street 1:10 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3604
Mailing Address - Country:US
Mailing Address - Phone:802-316-8660
Mailing Address - Fax:
Practice Address - Street 1:10 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3604
Practice Address - Country:US
Practice Address - Phone:802-316-8660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health