Healthcare Provider Details

I. General information

NPI: 1942726351
Provider Name (Legal Business Name): RONALD CALVIN BURTON CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10543 S CRATER RD
SOUTH PRINCE GEORGE VA
23805-7333
US

IV. Provider business mailing address

6521 OCTAGON DR APT 2C
NORTH CHESTERFIELD VA
23234-6156
US

V. Phone/Fax

Practice location:
  • Phone: 804-431-5585
  • Fax: 804-431-5820
Mailing address:
  • Phone: 804-901-1308
  • Fax: 804-901-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: