Provider Demographics
NPI:1205288289
Name:REGINA ABDOU
Entity type:Organization
Organization Name:REGINA ABDOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCAS
Authorized Official - Phone:914-552-5131
Mailing Address - Street 1:114 ROSEDALE CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4604
Mailing Address - Country:US
Mailing Address - Phone:914-552-5131
Mailing Address - Fax:
Practice Address - Street 1:114 ROSEDALE CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4604
Practice Address - Country:US
Practice Address - Phone:914-552-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty