Healthcare Provider Details

I. General information

NPI: 1194633289
Provider Name (Legal Business Name): REGINA HALEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SUNRISE AVE STE 100
ROSEVILLE CA
95661-4106
US

IV. Provider business mailing address

406 SUNRISE AVE STE 100
ROSEVILLE CA
95661-4106
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-3737
  • Fax:
Mailing address:
  • Phone: 916-782-3737
  • Fax: 916-782-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1443370526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: