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General NPI Number Information
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NPI Number | 1669017075
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Entity Type | Organization
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Legal Business Name | LEIGH REGINE LLC
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 114 E MAIN ST STE A1B-20
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City | BUFORD
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State | GA
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Zip | 30518
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Country | US
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Telephone | 219-898-9103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-898-9103
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEIGH REGINE WESTERGREN
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Credential | LCSW
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Telephone | 219-898-9103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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