Provider Demographics
NPI:1265671895
Name:FAGGINS, RONALD D (MED)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:FAGGINS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8461 FARM RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8306
Mailing Address - Country:US
Mailing Address - Phone:215-651-5654
Mailing Address - Fax:
Practice Address - Street 1:HARD KNOX REHABILITATION AND MENTORING SERVICE
Practice Address - Street 2:7473 W LAKE MEAD BLVD
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-562-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5312101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health