Provider Demographics
NPI:1700083326
Name:GENTRY, REGINA (MS, LPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:401 HUNTERS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8444
Mailing Address - Country:US
Mailing Address - Phone:864-229-5017
Mailing Address - Fax:864-366-8912
Practice Address - Street 1:901 W GREENWOOD ST STE 5
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5678
Practice Address - Country:US
Practice Address - Phone:864-993-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5236101YM0800X
SCLPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health