Active NPI
Ronald K Qualley, LAC
- Addiction (Substance Use Disorder) Counselor
- Williston, ND
National Provider Identifier
1174609671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1326
- Practice address
- 316 2ND Ave W
Williston, ND 58801-5218 - Phone
- (701) 774-4600
- Fax
- (701) 774-4620
- NPI assigned
- Oct 27, 2006
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1326 | ND | Primary |
Addresses
Primary practice location
316 2ND Ave W
Williston, ND 58801-5218
Mailing address
PO Box 1266
Williston, ND 58802-1266
Phone (701) 774-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54516 | Medicaid | ND |
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 |
|---|---|---|---|
| 1326 | ND | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174609671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1266",
"city": "WILLISTON",
"state": "ND",
"postal_code": "588021266",
"telephone_number": "701-774-4600",
"fax_number": "701-774-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 2ND AVE W",
"city": "WILLISTON",
"state": "ND",
"postal_code": "588015218",
"telephone_number": "701-774-4600",
"fax_number": "701-774-4620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUALLEY",
"first_name": "RONALD",
"middle_name": "K",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ND",
"license": "1326",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54516",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williston, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.