Provider Demographics
NPI:1306469945
Name:RIZEK, RONNIE IBRAHIM (LCMHC-A)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:IBRAHIM
Last Name:RIZEK
Suffix:
Gender:M
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHANDLER DR APT H
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6078
Mailing Address - Country:US
Mailing Address - Phone:716-201-6613
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7971
Practice Address - Country:US
Practice Address - Phone:919-706-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health