Provider Demographics
NPI:1457683963
Name:TOLSON, JOHN RAYMOND (MED, BCABA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAYMOND
Last Name:TOLSON
Suffix:
Gender:M
Credentials:MED, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S BOULEVARD APT 8
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5780
Mailing Address - Country:US
Mailing Address - Phone:804-513-4055
Mailing Address - Fax:
Practice Address - Street 1:205 S BOULEVARD APT 8
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5780
Practice Address - Country:US
Practice Address - Phone:804-513-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-08-2585103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst