Provider Demographics
NPI:1962861559
Name:SHELTON, REGINA DENICE (CSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:DENICE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE 379
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-741-2336
Mailing Address - Fax:502-813-8281
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 379
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-741-2336
Practice Address - Fax:502-813-8281
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7264101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical