| Doctor Name: | MS. NICHOLE MARIE REYNOLDS |
| NPI Number: | 1528331030 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ADC |
| License Number: | 2140 |
| Business Practice Address: | 19 Mdos/sgow 1090 Arnold Dr. Little Rock Afb, AR - 720994933 |
| Business Phone Number: | 5019877338 |
| Business Fax Number: | 5019878087 |
| Mailing Address: | 19 Mdos/sgow, 1090 Arnold Dr. LITTLE ROCK AFB |
| State: | AR |
| Postal Code: | 720994933 |
| Phone Number: | 5019877338 |
| Fax Number: | 5019878087 |
| NPI Enumeration Date: | 02/14/2012 |
| NPI Last Update Date: | 02/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2140 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |