Healthcare Provider Details

I. General information

NPI: 1942914643
Provider Name (Legal Business Name): CAROL REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLISEUM BLVD
MONTGOMERY AL
36109-2707
US

IV. Provider business mailing address

PO BOX 233
MONTGOMERY AL
36101-0233
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-7930
  • Fax:
Mailing address:
  • Phone: 334-279-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2662A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: