| Regina King Pllc | |
|
4230 N Parkside Ave Chicago IL 60634-1825 | |
| (630) 291-7825 | |
| Not Available |
| Full Name | Regina King Pllc |
|---|---|
| Speciality | Counselor |
| Location | 4230 N Parkside Ave, Chicago, Illinois |
| Authorized Official Name and Position | Regina King (OWNER/THERAPIST) |
| Authorized Official Contact | 6302917825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regina King Pllc 4230 N Parkside Ave Chicago IL 60634-1825 Ph: (630) 291-7825 | Regina King Pllc 4230 N Parkside Ave Chicago IL 60634-1825 Ph: (630) 291-7825 |
| NPI Number | 1528817335 |
|---|---|
| Provider Enumeration Date | 05/14/2024 |
| Last Update Date | 05/14/2024 |
| Certification Date | 05/08/2024 |
| Medicare PECOS PAC ID | 2365975133 |
|---|---|
| Medicare Enrollment ID | O20241031003211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528817335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Caitlin Gay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497443881 PECOS PAC ID: 6406397793 Enrollment ID: I20240926002797 |
| Provider Name | Vincent Rock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063127884 PECOS PAC ID: 4587197207 Enrollment ID: I20241101001280 |
| Provider Name | Regina King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649699315 PECOS PAC ID: 5890228662 Enrollment ID: I20241101002570 |
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