Provider Demographics
NPI:1760264097
Name:DIGIOVANNI, REYNA YERIM CHOI
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:YERIM CHOI
Last Name:DIGIOVANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E SAGINAW ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2326
Mailing Address - Country:US
Mailing Address - Phone:517-667-0061
Mailing Address - Fax:517-507-4888
Practice Address - Street 1:1801 E SAGINAW ST STE 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2326
Practice Address - Country:US
Practice Address - Phone:517-667-0061
Practice Address - Fax:517-507-4888
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2024-11-07
Deactivation Date:2024-09-26
Deactivation Code:
Reactivation Date:2024-10-30
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI68511187961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician