Provider Demographics
NPI:1922387695
Name:DEBLANC, RONALD LYNN (MA-PSY, LDCIII, SWA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LYNN
Last Name:DEBLANC
Suffix:
Gender:M
Credentials:MA-PSY, LDCIII, SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-0602
Mailing Address - Country:US
Mailing Address - Phone:937-754-0528
Mailing Address - Fax:
Practice Address - Street 1:1443 STEINER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3813
Practice Address - Country:US
Practice Address - Phone:937-754-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101064101YA0400X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral