Healthcare Provider Details

I. General information

NPI: 1114160983
Provider Name (Legal Business Name): DONNA LOUISA REENSTRA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 NORWICH AVE
COLCHESTER CT
06415-1230
US

IV. Provider business mailing address

195 TAYLOR RD
COLCHESTER CT
06415-1726
US

V. Phone/Fax

Practice location:
  • Phone: 860-931-7447
  • Fax:
Mailing address:
  • Phone: 860-537-3514
  • Fax: 860-889-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: