Basic Information
| Provider Information | |||||||||
| NPI: | 1366099426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAVERS | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | LEROY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 257 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450113277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138579389 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1910 FAIRGROVE AVE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450111930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138680055 | ||||||||
| FaxNumber: | 5137957557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.