Provider Demographics
NPI:1609111004
Name:LARGENT, REGINA L (MS, LMHC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:LARGENT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5859
Mailing Address - Country:US
Mailing Address - Phone:505-357-8099
Mailing Address - Fax:
Practice Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5859
Practice Address - Country:US
Practice Address - Phone:505-357-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0037101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)