Provider Demographics
NPI:1740590827
Name:FOURNIER, REGINA LEANNE (CATC II, CSC)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LEANNE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:CATC II, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 WILSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2144
Mailing Address - Country:US
Mailing Address - Phone:951-682-6631
Mailing Address - Fax:
Practice Address - Street 1:2452 WILSHIRE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2144
Practice Address - Country:US
Practice Address - Phone:951-682-6631
Practice Address - Fax:951-682-6614
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)