Healthcare Provider Details

I. General information

NPI: 1619993201
Provider Name (Legal Business Name): JAMES D DEKKER PHD CLINICAL PSYCHOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N CENTER DR STE 141 INTERSTATE CORPORATE CENTER BUILDING 11
NORFOLK VA
23502
US

IV. Provider business mailing address

420 N CENTER DR STE 141 INTERSTATE CORPORATE CENTER BUILDING 11
NORFOLK VA
23502
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-0700
  • Fax: 757-461-4826
Mailing address:
  • Phone: 757-466-0700
  • Fax: 757-461-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810001640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: