Provider Demographics
NPI:1174954408
Name:FAISON, REGINA
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:FAISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S PARSONS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6070
Mailing Address - Country:US
Mailing Address - Phone:813-662-9000
Mailing Address - Fax:813-662-9005
Practice Address - Street 1:911 S PARSONS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6070
Practice Address - Country:US
Practice Address - Phone:813-662-9000
Practice Address - Fax:813-662-9005
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health