Provider Demographics
NPI:1205093234
Name:GREY, REGINA M (LPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:GREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:GREY ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCMH
Mailing Address - Street 1:122 N DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1909
Mailing Address - Country:US
Mailing Address - Phone:302-661-1289
Mailing Address - Fax:302-661-1289
Practice Address - Street 1:122 N DUPONT RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1909
Practice Address - Country:US
Practice Address - Phone:302-661-1289
Practice Address - Fax:302-661-1289
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001331101YM0800X
DEPC-0000444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health