Provider Demographics
NPI:1023318045
Name:FARIDNIA, REGINA GUTHRIE (LCSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:GUTHRIE
Last Name:FARIDNIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:KINGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6049 DOUGLAS BLVD STE 20B
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6275
Mailing Address - Country:US
Mailing Address - Phone:408-460-5030
Mailing Address - Fax:916-540-7157
Practice Address - Street 1:6049 DOUGLAS BLVD STE 20B
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6275
Practice Address - Country:US
Practice Address - Phone:408-460-5030
Practice Address - Fax:916-540-7157
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45261041C0700X
CA267121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical