Doctor Name: | REGINA WAYNE |
NPI Number: | 1083943435 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, LADC |
License Number: | 00935 |
Business Practice Address: | 913 New Harwinton Rd Torrington, CT - 067905932 |
Business Phone Number: | 8603097262 |
Business Fax Number: | 8604820704 |
Mailing Address: | 913 New Harwinton Rd, TORRINGTON |
State: | CT |
Postal Code: | 067905932 |
Phone Number: | 8603097262 |
Fax Number: | 8604820704 |
NPI Enumeration Date: | 12/14/2009 |
NPI Last Update Date: | 03/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 00935 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |