Provider Demographics
NPI:1134775794
Name:MEAD, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:ST. PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1412
Mailing Address - Country:US
Mailing Address - Phone:850-723-1259
Mailing Address - Fax:
Practice Address - Street 1:1300 N PALAFOX ST STE 103
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2678
Practice Address - Country:US
Practice Address - Phone:850-723-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical