Basic Information
| Provider Information | |||||||||
| NPI: | 1720043953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCRIMMON | ||||||||
| FirstName: | RUSSEL | ||||||||
| MiddleName: | NORMAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TUNNEL RD | ||||||||
| Address2: | VA MEDICAL CENTER | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | 8282995897 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 TUNNEL RD | ||||||||
| Address2: | VA MEDICAL CENTER | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282987911 | ||||||||
| FaxNumber: | 8282995897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 624 | CO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.