Ronald Gray Medlin, Institute of Life and Health

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

LCA352 Issued in MD

Legal business name

RONALD GRAY MEDLIN, INSTITUTE OF LIFE AND HEALTH

Practice address

5311 Water St
Suite D
Upper Marlboro, MD 20772-3056

Phone

(301) 627-3007

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Gray Medlin, PH.D., LCADC

Title

Owner,Program Director

Phone

(301) 627-3007

Specialties & licenses 8

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1437375615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5311 WATER ST",
            "address_2": "SUITE D",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723056",
            "telephone_number": "301-627-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5311 WATER ST",
            "address_2": "SUITE D",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723056",
            "telephone_number": "301-627-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD GRAY MEDLIN, INSTITUTE OF LIFE AND HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "MEDLIN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "GRAY",
        "authorized_official_title_or_position": "OWNER,PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "301-627-3007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LCADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "LCA352",
            "primary": true
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "LCA352",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "GQ24RC",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Psychologist in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Addiction (Substance Use Disorder) Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.