Provider Demographics
NPI: | 1952488157 |
---|---|
Name: | SCHNEIDER, GORDON DOUGLAS (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GORDON |
Middle Name: | DOUGLAS |
Last Name: | SCHNEIDER |
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: | PO BOX 1085 |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28722-1085 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-894-2300 |
Mailing Address - Fax: | 828-894-8456 |
Practice Address - Street 1: | 799 W MILLS ST STE C |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28722-8645 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-894-2300 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-11-01 |
Last Update Date: | 2019-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 1908 | 103G00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0004X, 103TH0100X, 103TM1800X, 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health |
No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 6000122 | Medicaid | |
NC | 6000122 | Medicaid |