Basic Information
| Provider Information | |||||||||
| NPI: | 1942726351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | CALVIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6521 OCTAGON DR APT 2C | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232346156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049011308 | ||||||||
| FaxNumber: | 8049011308 | ||||||||
| Practice Location | |||||||||
| Address1: | 10543 S CRATER RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238057333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044315585 | ||||||||
| FaxNumber: | 8044315820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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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 | 101YA0400X | VA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.