Provider Demographics
NPI:1114987443
Name:ESSEX-DOHERTY, REGINA KAYE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:KAYE
Last Name:ESSEX-DOHERTY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:ESSEX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPC
Mailing Address - Street 1:2020 RAYBROOK ST SE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:616-464-1747
Mailing Address - Fax:866-366-7475
Practice Address - Street 1:2020 RAYBROOK ST SE
Practice Address - Street 2:SUITE 303
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-464-1747
Practice Address - Fax:866-366-7475
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1882516101YP2500X
MIL2027514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional