Provider Demographics
NPI:1053534776
Name:QUALLS, RONALD CHRISTOPHER (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CHRISTOPHER
Last Name:QUALLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4312
Mailing Address - Country:US
Mailing Address - Phone:276-783-2511
Mailing Address - Fax:276-783-2532
Practice Address - Street 1:1204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4312
Practice Address - Country:US
Practice Address - Phone:276-783-2511
Practice Address - Fax:276-783-2532
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945298Medicaid
VA176859OtherANTHEM