Provider Demographics
NPI:1306986112
Name:THOMAS, REGINA STONE (MS, LPE)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:STONE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, LPE
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:STONE
Other - Last Name:CHALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 ALDERSGATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 MAIN ST
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173
Practice Address - Country:US
Practice Address - Phone:501-772-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR89-06EI103T00000X
AR89-06E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health