Provider Demographics
NPI:1033921317
Name:COSTELLO-WHITE, REAGAN N (LCSW)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:N
Last Name:COSTELLO-WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7430
Mailing Address - Country:US
Mailing Address - Phone:214-995-0594
Mailing Address - Fax:
Practice Address - Street 1:4734 HICKORY HILL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-7430
Practice Address - Country:US
Practice Address - Phone:214-995-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040178961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical