Provider Demographics
NPI:1154352649
Name:KONKOLY, RONALD JAMES (PCC, LICDC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:KONKOLY
Suffix:
Gender:M
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 PADANARUM RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-8149
Mailing Address - Country:US
Mailing Address - Phone:440-415-0431
Mailing Address - Fax:
Practice Address - Street 1:388 S BROADWAY
Practice Address - Street 2:SUNRISE COUNSELING SERVICES
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1809
Practice Address - Country:US
Practice Address - Phone:440-466-0320
Practice Address - Fax:440-466-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976016101YA0400X
OHE-0003442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH358174OtherWELLCARE
OH341300581042OtherCARESOURCE
OH2457532Medicaid
OH745395OtherCENPATICO