Provider Demographics
NPI:1417351271
Name:RICH, RONNIE (DOCTOR OF DIVINITY)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:RICH
Suffix:
Gender:M
Credentials:DOCTOR OF DIVINITY
Other - Prefix:DR
Other - First Name:JOSIAH
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2581 GOBAR LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7699
Mailing Address - Country:US
Mailing Address - Phone:707-573-0156
Mailing Address - Fax:
Practice Address - Street 1:2581 GOBAR LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7699
Practice Address - Country:US
Practice Address - Phone:707-573-0156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral