Provider Demographics
NPI:1669504460
Name:BARNUM, REGINA KAY (CADC-II)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:KAY
Last Name:BARNUM
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:BROWNS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95918-0810
Mailing Address - Country:US
Mailing Address - Phone:530-692-8914
Mailing Address - Fax:
Practice Address - Street 1:1251 E ONSTOTT RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2439
Practice Address - Country:US
Practice Address - Phone:530-822-7263
Practice Address - Fax:530-822-7267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4001107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)