Provider Demographics
NPI:1003573551
Name:CROWDER-GALLOWAY, REGINA (MBA/MSW, RN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CROWDER-GALLOWAY
Suffix:
Gender:F
Credentials:MBA/MSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-0865
Mailing Address - Country:US
Mailing Address - Phone:704-455-1764
Mailing Address - Fax:704-455-1760
Practice Address - Street 1:500 SCHOOL CIR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9610
Practice Address - Country:US
Practice Address - Phone:704-455-1762
Practice Address - Fax:704-455-1760
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCC0138811041C0700X
NC297482163W00000X
NC5017401363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse