Provider Demographics
NPI:1518326396
Name:BROWN, REGINA W (LCPC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4018
Mailing Address - Country:US
Mailing Address - Phone:410-265-7291
Mailing Address - Fax:410-265-7294
Practice Address - Street 1:6665 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4018
Practice Address - Country:US
Practice Address - Phone:410-265-7291
Practice Address - Fax:410-265-7294
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00115373101Y00000X
MDLC6875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor