Active NPI
Ronald Wayne Lauderdale, MSSW
- Clinical Social Worker
- Knoxville, TN
National Provider Identifier
1124246145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4847
- Practice address
- 5117 Schubert Rd Ste #a
Christian Counseling Center
Knoxville, TN 37912-3871 - Phone
- (865) 689-3326
- Fax
- (865) 689-3326
- NPI assigned
- Apr 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4847 | TN | Primary |
Addresses
Primary practice location
5117 Schubert Rd Ste #a
Christian Counseling Center
Knoxville, TN 37912-3871
Mailing address
1104 West Adair Dr
Knoxville, TN 37918-1527
Phone (865) 688-3326
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 138577 | Other | TN | VALUE OPTIMA |
| 5694663 | Other | TN | AETNA |
| 737240000 | Other | TN | MAGELLAN |
| 197473293284 | Medicaid | TN | |
| 3101178 | Other | TN | BC BST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4847 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1124246145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 WEST ADAIR DR",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379181527",
"telephone_number": "865-688-3326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5117 SCHUBERT RD STE #A",
"address_2": "CHRISTIAN COUNSELING CENTER",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379123871",
"telephone_number": "865-689-3326",
"fax_number": "865-689-3326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAUDERDALE",
"first_name": "RONALD",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "MSSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-23",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "4847",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIMA",
"identifier": "138577",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5694663",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "737240000",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "197473293284",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BST",
"identifier": "3101178",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.