Individual
REGINA GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASTER DEGREE
Contact information
Practice address
OFF HIGHWAY 191, PHS/IHS DRIVE, PO DRAWER PH, CHINLE, AZ 86503
(928) 674-7378
(928) 674-7600
Mailing address
PO DRAWER PH, OFF HIGHWAY 191, PHS/IHS DRIVE, CHINLE, AZ 86503
(928) 674-7387
(928) 674-7600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LASAC-15475
AZ
Other
Enumeration date
07/12/2019
Last updated
04/19/2023
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