Provider Demographics
NPI:1649377896
Name:BLADE, RONALD T (LPC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:BLADE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 GUM ROCK CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2523
Mailing Address - Country:US
Mailing Address - Phone:757-873-2273
Mailing Address - Fax:757-873-9422
Practice Address - Street 1:707 GUM ROCK CT
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2523
Practice Address - Country:US
Practice Address - Phone:757-873-2273
Practice Address - Fax:757-873-9422
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5408211Medicaid