Healthcare Provider Details

I. General information

NPI: 1205812914
Provider Name (Legal Business Name): RALEIGH PSYCHIATRIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MALLARD CT
BECKLEY WV
25801-3664
US

IV. Provider business mailing address

PO BOX 1025
BECKLEY WV
25802-1025
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8409
  • Fax: 304-252-0022
Mailing address:
  • Phone: 304-252-8409
  • Fax: 304-252-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN HENRY JOHNSON JR.
Title or Position: CEO
Credential: MSW
Phone: 304-252-8409