Provider Demographics
NPI:1750472072
Name:MIDGETT, REGINA GAIL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:GAIL
Last Name:MIDGETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CANAL DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-6000
Mailing Address - Country:US
Mailing Address - Phone:910-386-6640
Mailing Address - Fax:
Practice Address - Street 1:2002 EASTWOOD RD
Practice Address - Street 2:STE 305
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7218
Practice Address - Country:US
Practice Address - Phone:910-509-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS964101YP2500X
NC7558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104734Medicaid