MEDICARE: MR. RONALD JAMES KONKOLY PCC, LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	976016	OH
2	101YP2500X	Professional Counselor	E-0003442	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	358174	OTHER	OH	WELLCARE
2	341300581042	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	745395	OTHER	OH	CENPATICO

General Provider Information

NPI Number	:	1154352649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD JAMES KONKOLY PCC, LICDC

Provider Business Mailing Address
First Line	:	3048 PADANARUM RD
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-8149
Country	:	US
Telephone Number	:	440-415-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 S BROADWAY
Second Line	:	SUNRISE COUNSELING SERVICES
City	:	GENEVA
State	:	OH
Zip	:	44041-1809
Country	:	US
Telephone Number	:	440-466-0320
Fax Number	:	440-466-0319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/04/2026

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