Provider Demographics
NPI:1518095736
Name:RYAN, ROBERT D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4273
Mailing Address - Country:US
Mailing Address - Phone:706-275-8104
Mailing Address - Fax:706-275-8134
Practice Address - Street 1:203 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-4273
Practice Address - Country:US
Practice Address - Phone:706-275-8104
Practice Address - Fax:706-275-8134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical