Provider Demographics
NPI:1700839594
Name:MCANULTY, RICHARD D (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:MCANULTY
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 1:8505 LOCKERBIE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7321
Mailing Address - Country:US
Mailing Address - Phone:704-609-6215
Mailing Address - Fax:
Practice Address - Street 1:6201 FAIRVIEW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3289
Practice Address - Country:US
Practice Address - Phone:704-687-4783
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical