Healthcare Provider Details

I. General information

NPI: 1922387695
Provider Name (Legal Business Name): RONALD LYNN DEBLANC MA-PSY, LDCIII, SWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 STEINER AVE
DAYTON OH
45417-3813
US

IV. Provider business mailing address

PO BOX 602
FAIRBORN OH
45324-0602
US

V. Phone/Fax

Practice location:
  • Phone: 937-754-0528
  • Fax:
Mailing address:
  • Phone: 937-754-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101064
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: