Healthcare Provider Details

I. General information

NPI: 1114987443
Provider Name (Legal Business Name): REGINA KAYE ESSEX-DOHERTY MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA ESSEX MA LPC

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE SUITE 303
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

2020 RAYBROOK ST SE SUITE 303
GRAND RAPIDS MI
49546-7717
US

V. Phone/Fax

Practice location:
  • Phone: 616-464-1747
  • Fax: 866-366-7475
Mailing address:
  • Phone: 616-464-1747
  • Fax: 866-366-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL1882516
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL2027514
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: