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General NPI Number Information
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NPI Number | 1861971715
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Entity Type | Individual
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Provider Name | ALEX REGAN LLMSW
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Gender | Male
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Dates
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Enumeration Date | 08/11/2018
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Last Update Date | 08/11/2018
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Provider Practice Location Address
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Address Line | 5820 N CANTON CENTER RD STE 186
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City | CANTON
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State | MI
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Zip | 48187-2600
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Country | US
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Telephone | 313-652-2432
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Fax | 734-667-2201
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Provider Business Mailing Address
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Address Line | 28298 HOOVER RD APT 4
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City | WARREN
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State | MI
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Zip | 48093-4121
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Country | US
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Telephone | 810-588-0790
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801102867
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License Number State | MI
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