Provider Demographics
NPI:1477072668
Name:CANTRELL, REGINA AUDREY
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:AUDREY
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 TRADEWIND DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-7561
Mailing Address - Country:US
Mailing Address - Phone:916-583-2026
Mailing Address - Fax:
Practice Address - Street 1:1418 TRADEWIND DR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-7561
Practice Address - Country:US
Practice Address - Phone:916-583-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician