Provider Demographics
NPI:1417430984
Name:REINA, MICHELE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:REINA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BRYSON GAP DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0182
Mailing Address - Country:US
Mailing Address - Phone:716-866-4260
Mailing Address - Fax:
Practice Address - Street 1:200 S HERLONG AVE STE C
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-323-2854
Practice Address - Fax:803-323-2856
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22211363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health