Provider Demographics
NPI:1467643924
Name:CARACTER, RONALD JACKSON
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JACKSON
Last Name:CARACTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3828
Mailing Address - Country:US
Mailing Address - Phone:415-621-5661
Mailing Address - Fax:415-621-5466
Practice Address - Street 1:54 DORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3828
Practice Address - Country:US
Practice Address - Phone:415-621-5661
Practice Address - Fax:415-621-5466
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE #200346101YA0400X
CACAADAC #48488504101YA0400X
CANADAC #013941101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)