Provider Demographics
NPI:1477760312
Name:PELT, RONALD STANLEY (MS)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:STANLEY
Last Name:PELT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:STANLEY
Other - Last Name:PELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CEAP, LEAP
Mailing Address - Street 1:4400 PARK RD
Mailing Address - Street 2:STE 330
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3139
Mailing Address - Country:US
Mailing Address - Phone:704-529-1428
Mailing Address - Fax:704-529-5917
Practice Address - Street 1:4400 PARK RD
Practice Address - Street 2:STE 330
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3139
Practice Address - Country:US
Practice Address - Phone:704-529-1428
Practice Address - Fax:704-529-5917
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional