Provider Demographics
NPI:1356833347
Name:ROBERTSON, REGENIA SHEREE (MHP)
Entity Type:Individual
Prefix:MS
First Name:REGENIA
Middle Name:SHEREE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:3936 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-6409
Mailing Address - Country:US
Mailing Address - Phone:318-636-6002
Mailing Address - Fax:
Practice Address - Street 1:3936 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6409
Practice Address - Country:US
Practice Address - Phone:318-363-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1285093112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health