Provider Demographics
NPI:1467791426
Name:STACKHOUSE, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:STACKHOUSE
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 1:302 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4061
Mailing Address - Country:US
Mailing Address - Phone:434-709-8839
Mailing Address - Fax:
Practice Address - Street 1:302 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4061
Practice Address - Country:US
Practice Address - Phone:434-709-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator