| Doctor Name: | FRED RICHARD REYNOLDS |
| NPI Number: | 1871640920 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 1386 |
| Business Practice Address: | 252 Seavy Street Senoia, GA - 302760147 |
| Business Phone Number: | 7705991102 |
| Business Fax Number: | 7705990806 |
| Mailing Address: | Po Box 147, 252 Seavy Street SENOIA |
| State: | GA |
| Postal Code: | 302760147 |
| Phone Number: | 7705991102 |
| Fax Number: | 7705990806 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1386 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |