Healthcare Provider Details

I. General information

NPI: 1609111004
Provider Name (Legal Business Name): REGINA L LARGENT MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 11/15/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SOUTHERN BLVD SE STE 105
RIO RANCHO NM
87124-5859
US

IV. Provider business mailing address

3301 SOUTHERN BLVD SE STE 105
RIO RANCHO NM
87124-5859
US

V. Phone/Fax

Practice location:
  • Phone: 505-357-8099
  • Fax:
Mailing address:
  • Phone: 505-357-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: