Provider Demographics
NPI:1790867877
Name:CLINTON, REGINA ELIZABETH (LPT/RRW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ELIZABETH
Last Name:CLINTON
Suffix:
Gender:F
Credentials:LPT/RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 MAS AMILOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2412
Mailing Address - Country:US
Mailing Address - Phone:916-519-3969
Mailing Address - Fax:916-391-4247
Practice Address - Street 1:3406 MAS AMILOS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2412
Practice Address - Country:US
Practice Address - Phone:916-519-3969
Practice Address - Fax:916-391-4247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty