Healthcare Provider Details

I. General information

NPI: 1700379468
Provider Name (Legal Business Name): REGINA NEAL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

DEPARTMENT 781625 P.O. BOX 78000
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-9372
  • Fax: 614-722-9376
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: