Provider Demographics
NPI:1295078269
Name:DAVIS, REGINALD LEE (INSTRUCTOR)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 ELDERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-2133
Mailing Address - Country:US
Mailing Address - Phone:843-767-1251
Mailing Address - Fax:843-760-1042
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6439
Practice Address - Country:US
Practice Address - Phone:843-871-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor