Provider Demographics
NPI:1669972568
Name:EDWARDS, REGINA (MHS)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:EDWARDS
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHS
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-0364
Mailing Address - Country:US
Mailing Address - Phone:224-442-2485
Mailing Address - Fax:
Practice Address - Street 1:200 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6447
Practice Address - Country:US
Practice Address - Phone:504-821-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty