Provider Demographics
NPI:1437235736
Name:MCIVER, REGINA E (MSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:E
Last Name:MCIVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 CASS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1705
Mailing Address - Country:US
Mailing Address - Phone:313-303-9847
Mailing Address - Fax:313-833-3704
Practice Address - Street 1:11800 E. TWELVE ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2405
Practice Address - Country:US
Practice Address - Phone:586-573-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010169821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical