Healthcare Provider Details

I. General information

NPI: 1083367213
Provider Name (Legal Business Name): REGINA M CARROLL LCSW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax:
Mailing address:
  • Phone: 757-460-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REGINA M CARROLL
Title or Position: OWNER
Credential:
Phone: 757-460-4655