Provider Demographics
NPI:1124246780
Name:WEAD, REGINA (MFT)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:WEAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 CANTERBURY DR
Mailing Address - Street 2:#114
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7184
Mailing Address - Country:US
Mailing Address - Phone:310-342-9883
Mailing Address - Fax:
Practice Address - Street 1:6140 CANTERBURY DR
Practice Address - Street 2:#114
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7184
Practice Address - Country:US
Practice Address - Phone:310-342-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43404106H00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional