Provider Demographics
NPI:1588978464
Name:CONWAY, REGENIA M (MHP)
Entity type:Individual
Prefix:MRS
First Name:REGENIA
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 HIGHWAY 62 412 STE C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9201
Mailing Address - Country:US
Mailing Address - Phone:870-856-2044
Mailing Address - Fax:844-360-6320
Practice Address - Street 1:2852C HIGHWAY 62 412
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:AR
Practice Address - Zip Code:72542
Practice Address - Country:US
Practice Address - Phone:870-856-2044
Practice Address - Fax:844-360-6320
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARP1409070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health