Provider Demographics
NPI:1720175706
Name:WARREN, REGINA A (LCPC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:A
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 BAY DALE DR
Mailing Address - Street 2:300
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2325
Mailing Address - Country:US
Mailing Address - Phone:410-271-2905
Mailing Address - Fax:410-757-4221
Practice Address - Street 1:1298 BAY DALE DR
Practice Address - Street 2:216
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2804
Practice Address - Country:US
Practice Address - Phone:410-271-2905
Practice Address - Fax:410-757-4221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional