Provider Demographics
NPI:1841318730
Name:RADSON, ROBERT D (MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:RADSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1706
Mailing Address - Country:US
Mailing Address - Phone:252-446-7673
Mailing Address - Fax:
Practice Address - Street 1:301 S CHURCH ST STE 262
Practice Address - Street 2:SUITE 262
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5749
Practice Address - Country:US
Practice Address - Phone:252-446-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107236Medicaid