Provider Demographics
NPI:1154792430
Name:REYNOLDS, CHRISTY RAE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FRONT ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1439
Mailing Address - Country:US
Mailing Address - Phone:716-359-2608
Mailing Address - Fax:
Practice Address - Street 1:2121 SAN DIEGO AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2928
Practice Address - Country:US
Practice Address - Phone:619-497-8457
Practice Address - Fax:619-497-8295
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI172481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical