Provider Demographics
NPI:1659331825
Name:KOLOTKIN, RONETTE L (PHD)
Entity Type:Individual
Prefix:
First Name:RONETTE
Middle Name:L
Last Name:KOLOTKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1038
Mailing Address - Country:US
Mailing Address - Phone:919-493-9995
Mailing Address - Fax:919-493-9925
Practice Address - Street 1:18 W COLONY PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5582
Practice Address - Country:US
Practice Address - Phone:919-493-2674
Practice Address - Fax:919-493-1923
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03876Medicare UPIN