Provider Demographics
NPI:1326218991
Name:SMITH, RONNIE COLMAN (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:COLMAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632
Mailing Address - Country:US
Mailing Address - Phone:703-980-8908
Mailing Address - Fax:
Practice Address - Street 1:1200 N GLENN ENGLISH ST
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-2015
Practice Address - Country:US
Practice Address - Phone:703-980-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW74411041C0700X
OK44301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical