Provider Demographics
NPI:1033252465
Name:RYAN, KEVIN J (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 TROON LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1829
Mailing Address - Country:US
Mailing Address - Phone:919-384-0323
Mailing Address - Fax:
Practice Address - Street 1:5127 TROON LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1829
Practice Address - Country:US
Practice Address - Phone:919-384-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC74105OtherBLUE CROSS BLUE SHIELD
NC19645OtherMAGELAN