Provider Demographics
NPI:1750312591
Name:SMITH, REGINA FRANCINE (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:FRANCINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:VA
Mailing Address - Zip Code:23890
Mailing Address - Country:US
Mailing Address - Phone:804-834-2205
Mailing Address - Fax:804-834-2625
Practice Address - Street 1:232 COPPAHAUNK AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890
Practice Address - Country:US
Practice Address - Phone:804-834-2205
Practice Address - Fax:804-834-2625
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040023651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106616OtherANTHEM
VA117954OtherANTHEM
VA086375OtherSENTARA
VA4945280Medicaid
VA4945280Medicaid