Provider Demographics
NPI:1508008277
Name:PALLICK, RONALD JOHN (LCAS, P-LCSW, LSSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JOHN
Last Name:PALLICK
Suffix:
Gender:M
Credentials:LCAS, P-LCSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LOCUST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-2713
Mailing Address - Country:US
Mailing Address - Phone:828-765-4463
Mailing Address - Fax:828-765-6257
Practice Address - Street 1:205 LOCUST AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-2713
Practice Address - Country:US
Practice Address - Phone:828-765-4463
Practice Address - Fax:828-765-6257
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1329101YA0400X
NCP0044101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical