Provider Demographics
NPI:1346210861
Name:CARR, REAGON PERCY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:REAGON
Middle Name:PERCY
Last Name:CARR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GOSS ROAD
Mailing Address - Street 2:USA MEDDAC ATTN: CREDENTIALS
Mailing Address - City:REDSTONE ARSENAL
Mailing Address - State:AL
Mailing Address - Zip Code:35809-7000
Mailing Address - Country:US
Mailing Address - Phone:913-240-4433
Mailing Address - Fax:
Practice Address - Street 1:4100 GOSS RD SW
Practice Address - Street 2:USA MEDDAC ATTN: CREDENTIALS
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35809-0001
Practice Address - Country:US
Practice Address - Phone:256-955-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN