Healthcare Provider Details

I. General information

NPI: 1699439539
Provider Name (Legal Business Name): REGAN HOLCOMBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 COLUMBIANA RD
VESTAVIA HILLS AL
35216-2139
US

IV. Provider business mailing address

2081 COLUMBIANA RD
VESTAVIA HILLS AL
35216-2139
US

V. Phone/Fax

Practice location:
  • Phone: 205-991-2584
  • Fax: 205-991-4829
Mailing address:
  • Phone: 205-991-2584
  • Fax: 205-991-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB522980
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2021-094
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: