Provider Demographics
NPI:1699439539
Name:HOLCOMBE, REGAN
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 COLUMBIANA RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2139
Mailing Address - Country:US
Mailing Address - Phone:205-991-2584
Mailing Address - Fax:205-991-4829
Practice Address - Street 1:2081 COLUMBIANA RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2139
Practice Address - Country:US
Practice Address - Phone:205-991-2584
Practice Address - Fax:205-991-4829
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB522980103K00000X
AL2021-094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty