Healthcare Provider Details

I. General information

NPI: 1891323895
Provider Name (Legal Business Name): REGINA DRAFFIN CCCII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BELLEVUE ST SE
WASHINGTON DC
20032-6030
US

IV. Provider business mailing address

1935 BROOKS DR
CAPITOL HEIGHTS MD
20743-5535
US

V. Phone/Fax

Practice location:
  • Phone: 202-562-4939
  • Fax: 202-562-5602
Mailing address:
  • Phone: 301-379-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCACII1180
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: