Healthcare Provider Details

I. General information

NPI: 1497780191
Provider Name (Legal Business Name): REGAN LEE HANNANT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WOOTEN BLVD SW STE K
WILSON NC
27893-4464
US

IV. Provider business mailing address

779 TRUE VINE RD. NE
PIKEVILLE NC
27863-8800
US

V. Phone/Fax

Practice location:
  • Phone: 252-291-0735
  • Fax: 252-291-2890
Mailing address:
  • Phone: 919-252-4816
  • Fax: 919-734-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005003
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6003749
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: