Individual
CONNIE REGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4100 MAMIE ST, HATTIESBURG, MS 39402-1735
(601) 705-1901
Mailing address
141 WILLOW BROOK DR, HATTIESBURG, MS 39402-1488
(601) 705-1901
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C1017
MS
106H00000X
Marriage & Family Therapist
C1017
MS
Other
Enumeration date
08/14/2009
Last updated
12/04/2015
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