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General NPI Number Information
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NPI Number | 1770857807
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Entity Type | Individual
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Provider Name | REGINA T DMOCH CAC,ICADC, SAP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 117 W 21ST ST SUITE 209
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City | NORFOLK
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State | VA
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Zip | 23517-2246
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Country | US
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Telephone | 757-613-8549
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Fax | 757-228-3061
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Provider Business Mailing Address
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Address Line | 117 W 21ST ST SUITE 209
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City | NORFOLK
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State | VA
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Zip | 23517-2246
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Country | US
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Telephone | 757-613-8549
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Fax | 757-228-3061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC-4066
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 125312
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | SAP20172
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License Number State | VA
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