Provider Demographics
NPI:1710680418
Name:DREGGORS, MARY (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DREGGORS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 COUNTY ROAD 13
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-4414
Mailing Address - Country:US
Mailing Address - Phone:386-295-2911
Mailing Address - Fax:
Practice Address - Street 1:3008 COUNTY ROAD 13
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-4414
Practice Address - Country:US
Practice Address - Phone:386-295-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health