Basic Information
| Provider Information | |||||||||
| NPI: | 1417495458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | LINDSAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 PEACE HAVEN CT | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271064854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367227266 | ||||||||
| FaxNumber: | 3366088409 | ||||||||
| Practice Location | |||||||||
| Address1: | 1336 WESTGATE CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271032933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366088409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C012740 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.