Provider Demographics
NPI:1548841158
Name:REYNOLDS, FALLON M (ALC)
Entity type:Individual
Prefix:
First Name:FALLON
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ROCK LEDGE CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7682
Mailing Address - Country:US
Mailing Address - Phone:334-782-4803
Mailing Address - Fax:
Practice Address - Street 1:2742 CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3243
Practice Address - Country:US
Practice Address - Phone:334-647-1009
Practice Address - Fax:888-856-7677
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3450A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health