Provider Demographics
NPI:1427290212
Name:RHODES, REGINA KAY (LSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:KAY
Last Name:RHODES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N MARTIN LUTHER KING BLVD
Mailing Address - Street 2:208
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7676
Mailing Address - Country:US
Mailing Address - Phone:702-265-7651
Mailing Address - Fax:702-490-6808
Practice Address - Street 1:3925 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:208
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7676
Practice Address - Country:US
Practice Address - Phone:702-265-7651
Practice Address - Fax:702-490-6808
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4489-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV170046612Medicaid