Provider Demographics
NPI:1174284889
Name:CLARKE, RONALD JR (LSATP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:CLARKE
Suffix:JR
Gender:M
Credentials:LSATP
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSATP
Mailing Address - Street 1:312 BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2337
Mailing Address - Country:US
Mailing Address - Phone:434-250-9368
Mailing Address - Fax:
Practice Address - Street 1:127 TUNSTALL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4236
Practice Address - Country:US
Practice Address - Phone:434-835-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000508101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty