Regina Gorman, MASTER DEGREE
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Chinle, AZ
NPI 1376195024 · NPPES record last updated Apr 19, 2023
Key facts
- NPI
- 1376195024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LASAC-15475 (AZ)
- Practice address
- Off Highway 191, PHS/IHS Drive
PO Drawer PH
Chinle, AZ 86503 - Phone
- (928) 674-7378
- Fax
- (928) 674-7600
- NPI assigned
- Jul 12, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LASAC-15475 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LASAC-15475 | AZ | Yes |
Addresses
Primary practice location
Off Highway 191, PHS/IHS Drive
PO Drawer PH
Chinle, AZ 86503
Mailing address
PO Drawer PH
Off Highway 191, PHS/IHS Drive
Chinle, AZ 86503
Phone (928) 674-7387
Other providers in Chinle, AZ
- William L. Flood
- Michael Lee From
- Amanda Gelman
- David Gibrael
- Benjamin H Glick
- Susan R Graham
- Rachel Maria Gray
- Tristan Graymountain
- Melvin Griffin
- Guardian Flight LLC
All providers in Chinle, AZ · Addiction (Substance Use Disorder) Counselor in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.