Basic Information
| Provider Information | |||||||||
| NPI: | 1083688188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | S | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 239 | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229390239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409324629 | ||||||||
| FaxNumber: | 5409325875 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 N MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229392344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402132525 | ||||||||
| FaxNumber: | 5402132502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904001819 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 008929068 | 05 | VA | MEDICAID | 258368 | 01 | VA | ANTHEM | OTHER | 2074088 | 01 | VA | CIGNA BEHAVIORAL | OTHER | 8929068 | 01 | VA | VA PREMIER | OTHER | 083837 | 01 | VA | OPTIMA HEALTH | OTHER | 2235184 | 01 | VA | FIRST HEALTH | OTHER |