Basic Information
| Provider Information | |||||||||
| NPI: | 1497134704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RONAS | ||||||||
| FirstName: | CHARLES | ||||||||
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| Credential: | LLBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3554 RAINTREE CT SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159944270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 277 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | ALLEGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490101138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696735092 | ||||||||
| FaxNumber: | 2696864601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2015 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802088369 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.