Basic Information
| Provider Information | |||||||||
| NPI: | 1124033824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEBEUS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | JOHANNES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 CANTERBURY PL | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287042608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287827628 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14 S PACK SQ | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283335359 | ||||||||
| FaxNumber: | 8283335359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810002866 | VA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 3306 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 177786 | 01 | VA | ANTHEM/BCBS | OTHER | 010166543 | 05 | VA | MEDICAID |