Provider Demographics
NPI:1821273848
Name:DEACON, JOSEPH RIDGWAY III (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RIDGWAY
Last Name:DEACON
Suffix:III
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 1:300 ENOLA RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4608
Mailing Address - Country:US
Mailing Address - Phone:828-433-2897
Mailing Address - Fax:
Practice Address - Street 1:300 ENOLA RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4625
Practice Address - Country:US
Practice Address - Phone:828-584-0141
Practice Address - Fax:828-438-6519
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2809103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities