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General NPI Number Information
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NPI Number | 1124532775
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Entity Type | Individual
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Provider Name | GINA L. REYNOLDS LLMSW-CLINICAL
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Gender | Female
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 1121 VILLA LINDE CT
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City | FLINT
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State | MI
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Zip | 48532-3410
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Country | US
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Telephone | 810-869-9662
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Fax |
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Provider Business Mailing Address
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Address Line | 4351 WHEATLAND DR
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-8255
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Country | US
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Telephone | 810-869-9662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801101998
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License Number State | MI
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