Provider Demographics
NPI:1033621669
Name:HOOTEN-SANTIAGO, RONNIE DEAN (LCSW-C, LICSW)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:DEAN
Last Name:HOOTEN-SANTIAGO
Suffix:
Gender:M
Credentials:LCSW-C, LICSW
Other - Prefix:MR
Other - First Name:RONNIE
Other - Middle Name:DEAN
Other - Last Name:HOOTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17740 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7831
Mailing Address - Country:US
Mailing Address - Phone:240-291-4257
Mailing Address - Fax:
Practice Address - Street 1:17740 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7831
Practice Address - Country:US
Practice Address - Phone:240-291-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19649104100000X, 1041C0700X
RIISW031241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker