Provider Demographics
NPI:1790005379
Name:GOULD, REGINA (MA, LPC, NBCT)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:MA, LPC, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9434
Mailing Address - Country:US
Mailing Address - Phone:919-557-4424
Mailing Address - Fax:
Practice Address - Street 1:2515 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9434
Practice Address - Country:US
Practice Address - Phone:919-557-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional