Provider Demographics
NPI:1528151594
Name:STITH, REGENA ROSS (LPC)
Entity type:Individual
Prefix:MRS
First Name:REGENA
Middle Name:ROSS
Last Name:STITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:REGENA
Other - Middle Name:ROSS
Other - Last Name:TINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5004 MONUMENT AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:804-257-7171
Mailing Address - Fax:804-257-7171
Practice Address - Street 1:5004 MONUMENT AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-257-7171
Practice Address - Fax:804-257-7171
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192496OtherANTHEM
VA11527500OtherCAGH
VA081273MOtherSENTARA BEHAVIORAL HEALTH
VA7361759OtherAETNA