Provider Demographics
NPI:1861807331
Name:JAMES, RONALD (DD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 PECK ST
Mailing Address - Street 2:BREAKTHROUGH BELIEVERS RECOVERY AND HEALING CENTER
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2547
Mailing Address - Country:US
Mailing Address - Phone:231-563-0558
Mailing Address - Fax:
Practice Address - Street 1:1576 PECK ST
Practice Address - Street 2:BREAKTHROUGH BELIEVERS RECOVERY AND HEALING CENTER
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2547
Practice Address - Country:US
Practice Address - Phone:231-563-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2549158101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376866160Medicaid
MIMI6949Medicare Oscar/Certification