Provider Demographics
NPI:1194312843
Name:KIEM, REGINA RESTITUTA (LGPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:RESTITUTA
Last Name:KIEM
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15030-101 AVENUE, #1703
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V3R 0N3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15030-101 AVENUE, #1703
Practice Address - Street 2:
Practice Address - City:SURREY
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V3R 0N3
Practice Address - Country:CA
Practice Address - Phone:604-838-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health