Provider Demographics
NPI:1568655405
Name:DELOACH, RONNY (MS)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:
Last Name:DELOACH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4751
Mailing Address - Country:US
Mailing Address - Phone:662-328-9225
Mailing Address - Fax:
Practice Address - Street 1:302 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2504
Practice Address - Country:US
Practice Address - Phone:662-323-9261
Practice Address - Fax:662-324-9647
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health