Provider Demographics
NPI:1427175066
Name:TAMURA, RICHARD K (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:TAMURA
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 OLD LILESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2820
Mailing Address - Country:US
Mailing Address - Phone:704-694-6588
Mailing Address - Fax:704-694-6706
Practice Address - Street 1:704 OLD LILESVILLE RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2820
Practice Address - Country:US
Practice Address - Phone:704-694-6588
Practice Address - Fax:704-694-6706
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427175066Medicaid
NC6107286Medicaid