Provider Demographics
NPI:1346882214
Name:STONE, REGINA ANGELA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANGELA
Last Name:STONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6062 HEATHWICK CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3236
Mailing Address - Country:US
Mailing Address - Phone:703-282-4148
Mailing Address - Fax:703-239-1664
Practice Address - Street 1:4300A RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5307
Practice Address - Country:US
Practice Address - Phone:703-580-7210
Practice Address - Fax:703-580-7213
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008527101YM0800X
VA1039-07-004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962789495OtherORGANIZATIONAL NPI