Provider Demographics
NPI:1841026077
Name:WEATHERSBY, REGINA (LICSW, PIP)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2081
Mailing Address - Country:US
Mailing Address - Phone:205-601-7037
Mailing Address - Fax:
Practice Address - Street 1:122 COOPER AVE
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2081
Practice Address - Country:US
Practice Address - Phone:205-601-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3895C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical