Provider Demographics
NPI:1598041857
Name:HOLDEN, REGENIA K (LCDC)
Entity type:Individual
Prefix:
First Name:REGENIA
Middle Name:K
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CUTTING HORSE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2469
Mailing Address - Country:US
Mailing Address - Phone:512-466-1906
Mailing Address - Fax:
Practice Address - Street 1:825 CUTTING HORSE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2469
Practice Address - Country:US
Practice Address - Phone:512-466-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148686201Medicaid