Healthcare Provider Details

I. General information

NPI: 1649817560
Provider Name (Legal Business Name): RONALD KEITH NORMAN JR. LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 MEEKER AVE # 143
RICHMOND CA
94804-6410
US

IV. Provider business mailing address

2163 MEEKER AVE # 143
RICHMOND CA
94804-6410
US

V. Phone/Fax

Practice location:
  • Phone: 510-944-6800
  • Fax:
Mailing address:
  • Phone: 510-944-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC10076
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC10076
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLC10076
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8159
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC10076
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: