Provider Demographics
NPI:1114164233
Name:GREENWOOD, REGINA GOODSON (LMHC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:GOODSON
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-4313
Mailing Address - Country:US
Mailing Address - Phone:904-531-9752
Mailing Address - Fax:904-531-5149
Practice Address - Street 1:623 OAK ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4313
Practice Address - Country:US
Practice Address - Phone:904-531-9752
Practice Address - Fax:904-531-5149
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health