Provider Demographics
NPI:1497717649
Name:RYAN, SARA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JEAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PHILLIPS AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7251
Mailing Address - Country:US
Mailing Address - Phone:336-841-4307
Mailing Address - Fax:336-841-7267
Practice Address - Street 1:1001 PHILLIPS AVE
Practice Address - Street 2:STE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7251
Practice Address - Country:US
Practice Address - Phone:336-841-4307
Practice Address - Fax:336-841-7267
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0031481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1039020OtherCIGNA
NC182978OtherMEDCOST
NC5831735OtherAETNA
NC2777684000OtherMAGELLAN
NC6106137Medicaid
NC6106137Medicaid