Provider Demographics
NPI:1386401313
Name:REYNOLDS, ANGELA C (LACMH, NCC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LACMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PHILADELPHIA PIKE STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3166
Mailing Address - Country:US
Mailing Address - Phone:302-408-0848
Mailing Address - Fax:
Practice Address - Street 1:222 PHILADELPHIA PIKE STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3166
Practice Address - Country:US
Practice Address - Phone:302-408-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0010368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional