Provider Demographics
NPI:1902421183
Name:THOMPSON, REGAN N (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOOD DUCK LANE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8409
Mailing Address - Country:US
Mailing Address - Phone:304-375-8800
Mailing Address - Fax:304-375-8801
Practice Address - Street 1:1809 DUPONT RD STE 1
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-9704
Practice Address - Country:US
Practice Address - Phone:304-917-3521
Practice Address - Fax:304-917-3522
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009456801041C0700X
WVCP009456801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1902421183Medicaid