Provider Demographics
NPI:1770857807
Name:DMOCH, REGINA T (CAC,ICADC, SAP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:T
Last Name:DMOCH
Suffix:
Gender:F
Credentials:CAC,ICADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 21ST ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2246
Mailing Address - Country:US
Mailing Address - Phone:757-613-8549
Mailing Address - Fax:757-228-3061
Practice Address - Street 1:117 W 21ST ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2246
Practice Address - Country:US
Practice Address - Phone:757-613-8549
Practice Address - Fax:757-228-3061
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCAC-4066101YA0400X
CT125312101YA0400X
VASAP20172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional