Provider Demographics
NPI:1053462531
Name:HALL, REGINA CAROLYN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:CAROLYN
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31810 N MARKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2856
Mailing Address - Country:US
Mailing Address - Phone:248-210-7331
Mailing Address - Fax:
Practice Address - Street 1:6548 TOWN CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:248-453-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006836101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000260F7OtherHAP
MI750910932OtherBCCHRY
MI750910932OtherBCBS MEDICARE ADVANTAGE
MI750910932OtherBCTR
MI750910932OtherBCOOS
MI750910932OtherBCFED
MI750910932OtherBCMI
MIXX19153OtherHEALTHPLUS
MI019027OtherMIDWEST MEDICAID