Basic Information
| Provider Information | |||||||||
| NPI: | 1851677702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANVOORHIS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 CRESTLAND AVE SE | ||||||||
| Address2: | |||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447203365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304977383 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4641 FULTON DR NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304547917 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2011 | ||||||||
| LastUpdateDate: | 10/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.