Provider Demographics
NPI:1043347529
Name:HORN, RICHARD C (DMIN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:HORN
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571097
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1097
Mailing Address - Country:US
Mailing Address - Phone:336-716-0800
Mailing Address - Fax:336-716-0822
Practice Address - Street 1:306 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2762
Practice Address - Country:US
Practice Address - Phone:336-992-1793
Practice Address - Fax:336-993-6033
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105055Medicaid
NC131E3OtherBCBS
NCA0128OtherMEDCOST