Healthcare Provider Details

I. General information

NPI: 1154352649
Provider Name (Legal Business Name): RONALD JAMES KONKOLY PCC, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 S BROADWAY SUNRISE COUNSELING SERVICES
GENEVA OH
44041-1809
US

IV. Provider business mailing address

3048 PADANARUM RD
GENEVA OH
44041-8149
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-0320
  • Fax: 440-466-0319
Mailing address:
  • Phone: 440-415-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number976016
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0003442
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: