Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 102L00000X | Psychologist | 27276 | CA |
Y | 103T00000X | Psychologist | 27276 | CA |
NPI | 1013244748 |
---|---|
Provider Name | Dustin Reagin |
First Address | Napa, CA 94558-6293 |
Second Address | Napa, CA 94558-6293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2009 |
Last Update Date | 18/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28276 | (02) | CA |