Provider Demographics
NPI:1114271202
Name:SAYRE, RYAN BLACK (LCMHC NCC BCBA)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:BLACK
Last Name:SAYRE
Suffix:
Gender:F
Credentials:LCMHC NCC BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1111
Mailing Address - Country:US
Mailing Address - Phone:540-421-6220
Mailing Address - Fax:
Practice Address - Street 1:213 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1111
Practice Address - Country:US
Practice Address - Phone:540-421-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18584103K00000X
NC9387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst