Basic Information
| Provider Information | |||||||||
| NPI: | 1518365683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCONNELL | ||||||||
| FirstName: | RONALD | ||||||||
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| Credential: | BS, CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446221078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303430823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 897 E IRON AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303435555 | ||||||||
| FaxNumber: | 3303431601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2014 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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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 | 0600080 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.