Healthcare Provider Details

I. General information

NPI: 1093654014
Provider Name (Legal Business Name): REGINA S BOONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 FAHEY DR
APEX NC
27502-7083
US

IV. Provider business mailing address

1843 FAHEY DR
APEX NC
27502-7083
US

V. Phone/Fax

Practice location:
  • Phone: 919-619-1140
  • Fax:
Mailing address:
  • Phone: 919-619-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC007906
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: