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Individual

DONNA REYNOLDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICDC 161766

Contact information

Practice address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(740) 464-6640
Mailing address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(740) 646-6640

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
161766
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.163495
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCII.161484
OH
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0259184
OH
Enumeration date
11/15/2017
Last updated
11/19/2019
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