Provider Demographics
NPI:1861045866
Name:RONNEY, GREGG ALEXANDER (LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:ALEXANDER
Last Name:RONNEY
Suffix:
Gender:M
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 GETTYSBURG AVE N APT 67
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1927
Mailing Address - Country:US
Mailing Address - Phone:612-790-4258
Mailing Address - Fax:
Practice Address - Street 1:12400 GETTYSBURG AVE N APT 67
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-1927
Practice Address - Country:US
Practice Address - Phone:612-790-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303429101YA0400X
MN01006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)