Healthcare Provider Details

I. General information

NPI: 1811266893
Provider Name (Legal Business Name): RONALD A. ROSS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PINECREST RD
VIRGINIA BEACH VA
23464-1626
US

IV. Provider business mailing address

267 HUNTERS TRL
FRANKLIN NC
28734-2283
US

V. Phone/Fax

Practice location:
  • Phone: 757-713-2004
  • Fax:
Mailing address:
  • Phone: 757-713-2004
  • Fax: 828-524-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007504
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: