Provider Demographics
NPI:1336461342
Name:PAYLOR, RICKY (LCAS)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:PAYLOR
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4937
Mailing Address - Country:US
Mailing Address - Phone:919-906-4426
Mailing Address - Fax:919-496-2906
Practice Address - Street 1:408 W MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4937
Practice Address - Country:US
Practice Address - Phone:919-906-4426
Practice Address - Fax:336-647-4776
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806034Medicaid