Healthcare Provider Details

I. General information

NPI: 1780624437
Provider Name (Legal Business Name): RICHARD JOHNSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 ZILLICOA ST
ASHEVILLE NC
28801-1079
US

IV. Provider business mailing address

158 ZILLICOA ST
ASHEVILLE NC
28801-1079
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-9494
  • Fax: 828-250-0890
Mailing address:
  • Phone: 828-254-9494
  • Fax: 828-250-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1307
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1307
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: