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General NPI Number Information
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NPI Number | 1750724282
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Entity Type | Individual
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Provider Name | MONIQUE REYNOLDS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1497 CHAIN BRIDGE RD
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City | MC LEAN
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State | VA
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Zip | 22101-5728
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Country | US
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Telephone | 703-908-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 N STUART ST
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City | ARLINGTON
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State | VA
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Zip | 22207-5125
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Country | US
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Telephone | 703-517-4401
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 05099
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License Number State | MD
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