Healthcare Provider Details

I. General information

NPI: 1659984995
Provider Name (Legal Business Name): REGINA LYNN DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 1ST AVE STE 600
FAIRBANKS AK
99701-4899
US

IV. Provider business mailing address

1513 4TH AVE
FAIRBANKS AK
99701-4209
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-8251
  • Fax:
Mailing address:
  • Phone: 907-687-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number196318
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: