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NPI Code Detail

MEDICARE: MRS. REGINA LYNN KOLLER LPCC, CADC-II

MEDICARE: MRS. REGINA LYNN KOLLER LPCC, CADC-II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorRA862911CA
2101YP2500XProfessional Counselor2471CA

General Provider Information

NPI Number : 1538446455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REGINA LYNN KOLLER LPCC, CADC-II
Provider Business Mailing Address
First Line : 11440 W BERNARDO CT STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92127-1644
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11440 W BERNARDO CT STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92127-1644
Country : US
Telephone Number : 858-295-0594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2011
Last Update Date : 07/10/2022

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