Provider Demographics
NPI:1801053251
Name:DARDANES, REGINA ANN (MA, LPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:DARDANES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:CLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3168
Mailing Address - Country:US
Mailing Address - Phone:970-522-4549
Mailing Address - Fax:970-522-4211
Practice Address - Street 1:910 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3399
Practice Address - Country:US
Practice Address - Phone:970-867-4924
Practice Address - Fax:970-522-4211
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional