Provider Demographics
NPI:1861971715
Name:REGAN, ALEX (LLMSW)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:REGAN
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28298 HOOVER RD APT 4
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4121
Mailing Address - Country:US
Mailing Address - Phone:810-588-0790
Mailing Address - Fax:
Practice Address - Street 1:5820 N CANTON CENTER RD STE 186
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2600
Practice Address - Country:US
Practice Address - Phone:313-652-2432
Practice Address - Fax:734-667-2201
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011028671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical