Provider Demographics
NPI:1295187102
Name:KING, REGAN H (PSY D)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:H
Last Name:KING
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HIGH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1307
Mailing Address - Country:US
Mailing Address - Phone:443-480-8746
Mailing Address - Fax:
Practice Address - Street 1:315 HIGH ST
Practice Address - Street 2:STE 105
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1307
Practice Address - Country:US
Practice Address - Phone:443-480-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical