Provider Demographics
NPI:1538702493
Name:RIFFLE, RONALD LEE JR
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:RIFFLE
Suffix:JR
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 1:101 N LYNNHAVEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-309-0409
Mailing Address - Fax:
Practice Address - Street 1:101 N LYNNHAVEN RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-309-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health