MEDICARE: MS. REGINA ELIZABETH CLINTON LPT/RRW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	4001	CA

General Provider Information

NPI Number	:	1790867877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REGINA ELIZABETH CLINTON LPT/RRW

Provider Business Mailing Address
First Line	:	3406 MAS AMILOS WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2412
Country	:	US
Telephone Number	:	916-519-3969
Fax Number	:	916-391-4247

Provider Business Practice Location Address
First Line	:	3406 MAS AMILOS WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-2412
Country	:	US
Telephone Number	:	916-519-3969
Fax Number	:	916-391-4247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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