Healthcare Provider Details

I. General information

NPI: 1790058360
Provider Name (Legal Business Name): JOHN RESENDES M.A., LPA, HSP-PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BUTTONWOOD DR
HILLSBOROUGH NC
27278-9488
US

IV. Provider business mailing address

8390 SIX FORKS RD SUITE 201
RALEIGH NC
27615-3060
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-9688
  • Fax:
Mailing address:
  • Phone: 919-782-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4252
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: