Provider Demographics
NPI:1124033824
Name:DEBEUS, ROGER JOHANNES (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOHANNES
Last Name:DEBEUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 ARCHES BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0156
Mailing Address - Country:US
Mailing Address - Phone:828-782-7628
Mailing Address - Fax:
Practice Address - Street 1:14 S PACK SQ
Practice Address - Street 2:SUITE 350
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3511
Practice Address - Country:US
Practice Address - Phone:828-333-5359
Practice Address - Fax:828-333-5359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3306103TC0700X
VA0810002866103TC0700X
GAPSY004752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177786OtherANTHEM/BCBS
VA010166543Medicaid