Provider Demographics
NPI:1477647360
Name:REGAN, PAUL DAVID (MS, LPC, CPHQ)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:REGAN
Suffix:
Gender:M
Credentials:MS, LPC, CPHQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NAVAHO DRIVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-423-8962
Mailing Address - Fax:
Practice Address - Street 1:1100 NAVAHO DRIVE
Practice Address - Street 2:SUITE 114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-423-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional