Provider Demographics
NPI:1699288910
Name:HILL, RONALD G (LAC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:HILL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-3327
Mailing Address - Country:US
Mailing Address - Phone:605-698-3918
Mailing Address - Fax:605-698-4449
Practice Address - Street 1:388 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-3327
Practice Address - Country:US
Practice Address - Phone:605-698-3918
Practice Address - Fax:605-698-4449
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD31083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)