Healthcare Provider Details

I. General information

NPI: 1679914378
Provider Name (Legal Business Name): REGINA BURGESS CARRICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 MAPLE DR SUITE 1
MORGANTOWN WV
26505-0809
US

IV. Provider business mailing address

PO BOX 6230
WHEELING WV
26003-0722
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5751
  • Fax: 304-599-2124
Mailing address:
  • Phone: 304-242-7106
  • Fax: 304-242-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1578
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: