Provider Demographics
NPI:1083801781
Name:JAKE E. RICKETSON HIGH POINT PSYCHOLOGICAL ASSOC
Entity Type:Organization
Organization Name:JAKE E. RICKETSON HIGH POINT PSYCHOLOGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICKETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-887-7350
Mailing Address - Street 1:405 WESTWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4325
Mailing Address - Country:US
Mailing Address - Phone:336-887-7350
Mailing Address - Fax:336-887-7353
Practice Address - Street 1:405 WESTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4325
Practice Address - Country:US
Practice Address - Phone:336-887-7350
Practice Address - Fax:336-887-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty