Provider Demographics
NPI:1154448538
Name:YOUNG, REGINA SHERYL (CAC-M, SPEX, FAODP,)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:SHERYL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CAC-M, SPEX, FAODP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1015
Mailing Address - Country:US
Mailing Address - Phone:313-397-1306
Mailing Address - Fax:313-397-6010
Practice Address - Street 1:9605 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2139
Practice Address - Country:US
Practice Address - Phone:313-834-5930
Practice Address - Fax:313-834-4541
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)