Provider Demographics
NPI:1790441574
Name:CLINE, REGINA LEA (MFT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:LEA
Last Name:CLINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LEA
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:28242 PASEO CORRALES
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3316
Mailing Address - Country:US
Mailing Address - Phone:949-294-0356
Mailing Address - Fax:
Practice Address - Street 1:31371 RANCHO VIEJO RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1849
Practice Address - Country:US
Practice Address - Phone:949-294-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist