Individual
REGINA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3301 S CREEK DR SE APT 204, KENTWOOD, MI 49512-8335
(313) 960-3759
Mailing address
2013 EASTCASTLE DR SE STE B, GRAND RAPIDS, MI 49508-8873
(616) 888-1120
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6451018734
MI
101YM0800X
Mental Health Counselor
6451018734
FM
101YM0800X
Mental Health Counselor
Primary
6451018734
—
106S00000X
Behavior Technician
—
MI
Other
Enumeration date
04/10/2017
Last updated
06/27/2022
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