Provider Demographics
NPI:1548655004
Name:REGIS, NINIS (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:NINIS
Middle Name:
Last Name:REGIS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-1150
Mailing Address - Country:US
Mailing Address - Phone:252-426-7717
Mailing Address - Fax:252-426-8189
Practice Address - Street 1:123 W MARKET ST
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-1150
Practice Address - Country:US
Practice Address - Phone:252-426-7717
Practice Address - Fax:252-426-8189
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical