Provider Demographics
NPI:1811039068
Name:RHEAD, JOHN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:RHEAD
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 1:5560 STERRETT PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2601
Mailing Address - Country:US
Mailing Address - Phone:410-997-5060
Mailing Address - Fax:
Practice Address - Street 1:5560 STERRETT PL
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2601
Practice Address - Country:US
Practice Address - Phone:410-997-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD651103T00000X, 103TC0700X
103TA0400X, 103TA0700X, 103TB0200X, 103TC2200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
12522OtherNATIONAL REGISTER