Provider Demographics
NPI:1790058360
Name:RESENDES, JOHN (MA, LPA, HSP-PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:RESENDES
Suffix:
Gender:M
Credentials:MA, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 SIX FORKS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3060
Mailing Address - Country:US
Mailing Address - Phone:919-782-8730
Mailing Address - Fax:
Practice Address - Street 1:610 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9488
Practice Address - Country:US
Practice Address - Phone:919-732-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4252103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical