Provider Demographics
NPI:1922715135
Name:SMITH, REGINA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 MCMANAWAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3786
Mailing Address - Country:US
Mailing Address - Phone:804-972-7475
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S STE 110
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2919
Practice Address - Country:US
Practice Address - Phone:832-924-0348
Practice Address - Fax:832-852-5754
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011862101YP2500X
TX91394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional