Healthcare Provider Details

I. General information

NPI: 1972344679
Provider Name (Legal Business Name): DARRELL ANTHONY REYNOLDS CMAC, CACII, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 CLEVELAND HWY
CLERMONT GA
30527-1560
US

IV. Provider business mailing address

2736 NORTHLAKE RD
GAINESVILLE GA
30506-1835
US

V. Phone/Fax

Practice location:
  • Phone: 678-787-9454
  • Fax:
Mailing address:
  • Phone: 678-787-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: