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NPI Code Detail

MEDICARE: MR. MARC CLIFFORD REGAN

MEDICARE: MR. MARC CLIFFORD REGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701012333VA

General Provider Information

NPI Number : 1679268049
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC CLIFFORD REGAN
Provider Business Mailing Address
First Line : 104 WESSEX RD
Second Line :
City : LYNCHBURG
State : VA
Zip : 24501-3993
Country : US
Telephone Number : 434-473-0750
Fax Number :
Provider Business Practice Location Address
First Line : 20276 TIMBERLAKE RD STE A
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-7214
Country : US
Telephone Number : 434-319-5528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2023
Last Update Date : 04/10/2023

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