Provider Demographics
NPI:1649052622
Name:CLAIBORNE, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6146
Mailing Address - Country:US
Mailing Address - Phone:318-537-6557
Mailing Address - Fax:
Practice Address - Street 1:111 N VIOLET ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6146
Practice Address - Country:US
Practice Address - Phone:318-537-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral