Provider Demographics
NPI:1619993201
Name:DEKKER, JAMES D (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:DEKKER
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CENTER DR STE 141
Mailing Address - Street 2:INTERSTATE CORPORATE CENTER BUILDING 11
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-466-0700
Mailing Address - Fax:757-461-4826
Practice Address - Street 1:420 N CENTER DR STE 141
Practice Address - Street 2:INTERSTATE CORPORATE CENTER BUILDING 11
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-466-0700
Practice Address - Fax:757-461-4826
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001640103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R60443Medicare UPIN