Provider Demographics
NPI:1902237621
Name:PELLICER, RONALD PATRICK (MRC, LPC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:PATRICK
Last Name:PELLICER
Suffix:
Gender:M
Credentials:MRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 N TRENHOLM RD STE F102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1715
Mailing Address - Country:US
Mailing Address - Phone:803-331-2980
Mailing Address - Fax:803-753-9636
Practice Address - Street 1:6941 N TRENHOLM RD STE F102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206
Practice Address - Country:US
Practice Address - Phone:803-331-2980
Practice Address - Fax:803-753-9636
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional