Provider Demographics
NPI:1265505689
Name:STROUD, RON L (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:L
Last Name:STROUD
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3026
Mailing Address - Country:US
Mailing Address - Phone:843-442-9417
Mailing Address - Fax:
Practice Address - Street 1:200 E. 5TH NORTH ST.
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-572-8900
Practice Address - Fax:843-569-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1341101YP2500X
SC2092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker