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General NPI Number Information
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NPI Number | 1558735944
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Entity Type | Individual
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Provider Name | REGINA BLACKWELL
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Gender | Female
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 3201 FLORIN PERKINS RD
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City | SACRAMENTO
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State | CA
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Zip | 95827
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Country | US
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Telephone | 916-875-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 7416 GOLF CLUB CT
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City | SACRAMENTO
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State | CA
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Zip | 95828-4863
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Country | US
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Telephone | 916-256-6181
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C5541214
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | Q15308
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License Number State | CA
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