Provider Demographics
NPI:1578153821
Name:CARTER, REGINA NAOMI
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:NAOMI
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 MARINERS WAY
Mailing Address - Street 2:APT A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503
Mailing Address - Country:US
Mailing Address - Phone:757-240-0169
Mailing Address - Fax:
Practice Address - Street 1:641 MARINERS WAY
Practice Address - Street 2:APT A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503
Practice Address - Country:US
Practice Address - Phone:757-240-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator