Provider Demographics
NPI:1518943075
Name:VANHAVEREN, RICHARD ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:VANHAVEREN
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 1:3516 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4458
Mailing Address - Country:US
Mailing Address - Phone:678-462-3833
Mailing Address - Fax:678-205-4858
Practice Address - Street 1:3516 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4458
Practice Address - Country:US
Practice Address - Phone:678-462-3833
Practice Address - Fax:678-205-4858
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist