Provider Demographics
NPI:1982681037
Name:KRONLAGE, JAMES EDWARD (LCSW, ACSW, DCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:KRONLAGE
Suffix:
Gender:M
Credentials:LCSW, ACSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HORSESHOE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8507
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:252-335-9521
Practice Address - Street 1:1129 HORSESHOE ROAD
Practice Address - Street 2:ALBEMARLE COUNSELING GROUP
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8507
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:252-335-9521
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045661041C0700X
VA09040048551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002866Medicaid
NC6002866Medicaid