Provider Demographics
NPI:1497488092
Name:RYAN, LISA (CDCA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 STATE ROUTE 339
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5106
Mailing Address - Country:US
Mailing Address - Phone:740-993-0399
Mailing Address - Fax:
Practice Address - Street 1:4945 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5106
Practice Address - Country:US
Practice Address - Phone:740-993-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185440101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)