Individual provider Active NPI

Ronald Smith, PHD, LPC

  • Professional Counselor
  • Petersburg, VA
National Provider Identifier
1174008619
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701007760 Issued in VA
Practice address
20 W Bank St
Petersburg, VA 23803-3279
Phone
(804) 862-8023
NPI assigned
Oct 1, 2018
Last updated
Nov 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701007760 VA Primary

Addresses

Primary practice location

20 W Bank St
Petersburg, VA 23803-3279

Mailing address

20 W Bank St
Petersburg, VA 23803-3279
Phone (804) 862-8023

Other practice location 1

10710 Midlothian Tpke Ste 127
North Chesterfield, VA 23235-4776
Phone (804) 207-6737

Other identifiers 1

IdentifierTypeStateIssuer
30017646290001MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231215000687 VA Practitioner - Mental Health Counselor 7911356951 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Counseling Associates Inc Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

9202 Center Oak Ct
Mechanicsvlle, VA 23116
Phone (804) 639-1112

10710 Midlothian Tpke
Ste 127
North Chesterfield, VA 23235
Phone (804) 220-0903

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1174008619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W BANK ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033279",
            "telephone_number": "804-862-8023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W BANK ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238033279",
            "telephone_number": "804-862-8023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10710 Midlothian Tpke Ste 127",
            "address_purpose": "LOCATION",
            "city": "North Chesterfield",
            "state": "VA",
            "postal_code": "232354776",
            "country_code": "US",
            "telephone_number": "804-207-6737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RONALD",
        "credential": "PHD, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-01",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701007760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017646290001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.