Provider Demographics
NPI:1376712836
Name:BANCROFT, RONALD D (MA, LPC, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:MA, LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513
Mailing Address - Country:US
Mailing Address - Phone:252-746-5126
Mailing Address - Fax:
Practice Address - Street 1:417 A FIRST STREET
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513
Practice Address - Country:US
Practice Address - Phone:252-746-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3242;0151101YP2500X
NC3242 LPC;0151 LCAS101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional