Provider Demographics
NPI:1881702702
Name:ERVIN, REGINA L (LPC)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:L
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615D JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2326
Mailing Address - Country:US
Mailing Address - Phone:318-442-9999
Mailing Address - Fax:318-442-9976
Practice Address - Street 1:5615D JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2326
Practice Address - Country:US
Practice Address - Phone:318-442-9999
Practice Address - Fax:318-442-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health