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Individual

REGINA A LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAC

Contact information

Practice address
2060 N SHADELAND AVE, INDIANAPOLIS, IN 46219-1762
(317) 270-0710
Mailing address
9613 E 37TH PL, INDIANAPOLIS, IN 46235-2104
(317) 270-0710

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000231A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
86000231A
LICENSE NUMBER
IN
Enumeration date
08/25/2017
Last updated
08/25/2017
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