Provider Demographics
NPI:1083475578
Name:WILCOX-LEWIS, REGINA S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:S
Last Name:WILCOX-LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:S
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-815-3305
Mailing Address - Fax:
Practice Address - Street 1:140 CARL CIR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-4507
Practice Address - Country:US
Practice Address - Phone:601-946-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174H00000X
MSC110211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator