Provider Demographics
NPI:1841400629
Name:PROSKINE, REGENIA HAMPTON (MFT)
Entity Type:Individual
Prefix:MRS
First Name:REGENIA
Middle Name:HAMPTON
Last Name:PROSKINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 TEDDER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-3645
Mailing Address - Country:US
Mailing Address - Phone:386-804-9860
Mailing Address - Fax:
Practice Address - Street 1:217 E PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2881
Practice Address - Country:US
Practice Address - Phone:386-804-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4515OtherBLUE CROSS