Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | C013881 | NC |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 297482 | NC |
NPI | 1003573551 |
---|---|
Provider Name | Regina Crowder-Galloway |
First Address | Harrisburg, NC 28075-0865 |
Second Address | Harrisburg, NC 28075-9610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2021 |
Last Update Date | 20/11/2021 |