Provider Demographics
NPI:1083987820
Name:CASSIDY, RONALD SCOTT (LPC-S)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 48TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5425
Mailing Address - Country:US
Mailing Address - Phone:843-449-2576
Mailing Address - Fax:843-449-6851
Practice Address - Street 1:2402 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-8444
Practice Address - Country:US
Practice Address - Phone:843-222-7606
Practice Address - Fax:843-449-6851
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional