Provider Demographics
NPI:1326091604
Name:GORMAN, JOHN A (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:GORMAN
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:901 WILLOW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7078
Mailing Address - Country:US
Mailing Address - Phone:919-942-2363
Mailing Address - Fax:919-942-2761
Practice Address - Street 1:901 WILLOW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7078
Practice Address - Country:US
Practice Address - Phone:919-942-2363
Practice Address - Fax:919-942-2761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000017Medicaid
NC2810289Medicare ID - Type UnspecifiedPH.D PSYCHOLOGIST