Provider Demographics
NPI:1932505450
Name:FLACK, RONALD JR (LCAS, CSI)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:FLACK
Suffix:JR
Gender:M
Credentials:LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BOWMORE PL
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9248
Mailing Address - Country:US
Mailing Address - Phone:336-601-3621
Mailing Address - Fax:
Practice Address - Street 1:1520 BOWMORE PL
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9248
Practice Address - Country:US
Practice Address - Phone:336-601-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24002101YA0400X, 101YA0400X
NC101YP1600X
NC12972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral