Individual
MISS I REGINA GOURDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW , LCSW
Contact information
Practice address
9378 OLIVE BLVD STE 311, SAINT LOUIS, MO 63132-3224
(314) 845-3502
(314) 329-6858
Mailing address
9378 OLIVE BLVD STE 311, SAINT LOUIS, MO 63132-3224
(314) 845-3502
(314) 329-6858
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
004214
MO
374U00000X
Home Health Aide
—
MO
376J00000X
Homemaker
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493656805
—
MO
Enumeration date
03/02/2007
Last updated
07/03/2024
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