Provider Demographics
NPI:1235414095
Name:FEEMSTER, RYAN BENSON (MED, NCC, LPC-A)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:BENSON
Last Name:FEEMSTER
Suffix:
Gender:M
Credentials:MED, NCC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 HIGHWAY 160 W STE 4388
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8581
Mailing Address - Country:US
Mailing Address - Phone:803-526-3288
Mailing Address - Fax:803-675-5233
Practice Address - Street 1:2166 GOLD HILL RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9351
Practice Address - Country:US
Practice Address - Phone:803-526-3288
Practice Address - Fax:803-675-5233
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962736850OtherNPI