Provider Demographics
NPI:1780832931
Name:EGGLESTON, REGINALD LAMONT (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:LAMONT
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2409
Mailing Address - Country:US
Mailing Address - Phone:410-833-1965
Mailing Address - Fax:
Practice Address - Street 1:314 HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2409
Practice Address - Country:US
Practice Address - Phone:410-833-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD042491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical