Provider Demographics
NPI:1891129094
Name:WILLIAMS, REGINA GAVIN (NCC, LCMHC)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:GAVIN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WILDOAT PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2155
Mailing Address - Country:US
Mailing Address - Phone:229-402-3466
Mailing Address - Fax:
Practice Address - Street 1:404 WILDOAT PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2155
Practice Address - Country:US
Practice Address - Phone:229-402-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health