Provider Demographics
NPI:1700597226
Name:REYNOLDS, MADISON KAY (LCMHCA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KAY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 UNION RD STE C
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5581
Mailing Address - Country:US
Mailing Address - Phone:704-869-2047
Mailing Address - Fax:704-869-2047
Practice Address - Street 1:1554 UNION RD STE C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:704-869-2047
Practice Address - Fax:704-869-2047
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health