Provider Demographics
NPI:1326527375
Name:BURTT, REGINA GAIL (LCMHC, MLADC, SEP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:GAIL
Last Name:BURTT
Suffix:
Gender:F
Credentials:LCMHC, MLADC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SUSIE DRISCOLL ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223
Mailing Address - Country:US
Mailing Address - Phone:603-536-2271
Mailing Address - Fax:
Practice Address - Street 1:72 SUSIE DRISCOLL ROAD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223
Practice Address - Country:US
Practice Address - Phone:603-536-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor