Provider Demographics
NPI:1902421183
Name:THOMPSON, REGAN N (LICSW)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 DUPONT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-9704
Mailing Address - Country:US
Mailing Address - Phone:304-917-3521
Mailing Address - Fax:304-917-3521
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?:No
Enumeration Date:2020-06-12
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009456801041C0700X
WVDP009456801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1902421183Medicaid