1528151594 NPI number — MRS. REGENA ROSS STITH LPC

Table of content: MRS. REGENA ROSS STITH LPC (NPI 1528151594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528151594 NPI number — MRS. REGENA ROSS STITH LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STITH
Provider First Name:
REGENA
Provider Middle Name:
ROSS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TINNEY
Provider Other First Name:
REGENA
Provider Other Middle Name:
ROSS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528151594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5004 MONUMENT AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-257-7171
Provider Business Mailing Address Fax Number:
804-257-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5004 MONUMENT AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-257-7171
Provider Business Practice Location Address Fax Number:
804-257-7171
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701002834 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 192496 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11527500 . This is a "CAGH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 081273M . This is a "SENTARA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7361759 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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