Provider Demographics
NPI:1275557522
Name:REALON, RODNEY EUGENE (MA)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:EUGENE
Last Name:REALON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 HEDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6322
Mailing Address - Country:US
Mailing Address - Phone:919-676-4890
Mailing Address - Fax:
Practice Address - Street 1:5708 HEDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6322
Practice Address - Country:US
Practice Address - Phone:919-676-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0478103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral