Provider Demographics
NPI:1851919955
Name:TARVER, REGINA (LPC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:TARVER
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 1:4108 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3536
Mailing Address - Country:US
Mailing Address - Phone:814-881-8671
Mailing Address - Fax:855-558-5841
Practice Address - Street 1:3910 CAUGHEY RD STE 120
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4097
Practice Address - Country:US
Practice Address - Phone:814-314-9207
Practice Address - Fax:855-558-5841
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional