Provider Demographics
NPI:1043569544
Name:MORAN, REGINA ANNETTE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANNETTE
Last Name:MORAN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-7612
Mailing Address - Country:US
Mailing Address - Phone:610-775-1370
Mailing Address - Fax:610-376-2779
Practice Address - Street 1:4 S 4TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-2820
Practice Address - Country:US
Practice Address - Phone:610-376-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional