Provider Demographics
NPI:1740843382
Name:SMITH, RONNY (DRPH, MS, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:RONNY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DRPH, MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:
Practice Address - Street 1:9532 WYNLAKES PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8515
Practice Address - Country:US
Practice Address - Phone:334-270-3181
Practice Address - Fax:334-270-5805
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AL3368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty