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General NPI Number Information
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NPI Number | 1477048817
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Entity Type | Individual
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Provider Name | MRS. CINA CIMONE SADE REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 6555 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-2713
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Country | US
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Telephone | 586-719-3938
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-2713
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Country | US
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Telephone | 586-719-3938
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | B653116758091
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License Number State | MI
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