Provider Demographics
NPI:1881811941
Name:SKIDMORE, RONALD CRAIG (MA, MA, MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CRAIG
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:MA, MA, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 MACKINAW RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3349
Mailing Address - Country:US
Mailing Address - Phone:616-241-2413
Mailing Address - Fax:
Practice Address - Street 1:1514 WEALTHY ST SE
Practice Address - Street 2:SUITE 260
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:616-451-3008
Practice Address - Fax:616-451-3070
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)