Provider Demographics
NPI:1336230325
Name:DAVES, DEWEY RICHARD (MA)
Entity Type:Individual
Prefix:MR
First Name:DEWEY
Middle Name:RICHARD
Last Name:DAVES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-3704
Mailing Address - Country:US
Mailing Address - Phone:252-329-7366
Mailing Address - Fax:252-329-7366
Practice Address - Street 1:128 N LONGMEADOW RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-3704
Practice Address - Country:US
Practice Address - Phone:252-329-7366
Practice Address - Fax:252-329-7366
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist