Provider Demographics
NPI:1609070234
Name:HOLMES, REGINA NOWELL (MFT)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:NOWELL
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:NOWELL
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:9310 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5711
Mailing Address - Country:US
Mailing Address - Phone:866-205-3595
Mailing Address - Fax:
Practice Address - Street 1:9310 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5711
Practice Address - Country:US
Practice Address - Phone:909-427-3700
Practice Address - Fax:909-427-3750
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist