Healthcare Provider Details

I. General information

NPI: 1124033824
Provider Name (Legal Business Name): ROGER JOHANNES DEBEUS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S PACK SQ SUITE 350
ASHEVILLE NC
28801-3511
US

IV. Provider business mailing address

3196 ARCHES BLUFF CIR
LANCASTER SC
29720-0156
US

V. Phone/Fax

Practice location:
  • Phone: 828-333-5359
  • Fax: 828-333-5359
Mailing address:
  • Phone: 828-782-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY004752
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3306
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002866
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: