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General NPI Number Information
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NPI Number | 1316346273
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Entity Type | Individual
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Provider Name | REGINA VICTORIA FOLEN BAS
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Gender | Female
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Dates
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Enumeration Date | 08/17/2014
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 405 S SUMMIT ST STE E
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City | CRESCENT CITY
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State | FL
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Zip | 32112
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Country | US
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Telephone | 904-803-1581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | CRESCENT CITY
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State | FL
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Zip | 32112-0826
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Country | US
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Telephone | 386-546-5046
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Fax | 888-686-1405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | FL
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