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General NPI Number Information
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NPI Number | 1417337361
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Entity Type | Individual
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Provider Name | KEVIN RICHARD PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1601 BRENNER AVE
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City | SALISBURY
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State | NC
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Zip | 28144
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Country | US
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Telephone | 702-638-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SUNSET DR APT 224
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City | SALISBURY
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State | NC
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Zip | 28147-7144
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Country | US
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Telephone | 701-260-2421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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