Provider Demographics
NPI:1033990841
Name:BRODIE, RONNIE JR (LCSW-A)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:BRODIE
Suffix:JR
Gender:M
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WEEKS DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3929
Mailing Address - Country:US
Mailing Address - Phone:336-514-9399
Mailing Address - Fax:
Practice Address - Street 1:145 WEEKS DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-3929
Practice Address - Country:US
Practice Address - Phone:336-514-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer