Provider Demographics
NPI:1689720609
Name:FRANK REYNOLDS, PH.D., P.C.
Entity type:Organization
Organization Name:FRANK REYNOLDS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:G
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-422-4801
Mailing Address - Street 1:1604 HILLTOP WEST SHOPPING CTR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6141
Mailing Address - Country:US
Mailing Address - Phone:757-422-4801
Mailing Address - Fax:757-422-1259
Practice Address - Street 1:1604 HILLTOP WEST SHOPPING CTR
Practice Address - Street 2:SUITE 217
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6141
Practice Address - Country:US
Practice Address - Phone:757-422-4801
Practice Address - Fax:757-422-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherGROUP ID
VAC09717Medicare ID - Type UnspecifiedGROUP ID