Provider Demographics
NPI:1720043953
Name:MCCRIMMON, RUSSEL NORMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:NORMAN
Last Name:MCCRIMMON
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 1:1100 TUNNEL RD
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-298-7911
Mailing Address - Fax:828-299-5897
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:828-299-5897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO624103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist