Provider Demographics
NPI:1558008466
Name:AVERY, RYAN A (CDCA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:AVERY
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2139
Mailing Address - Country:US
Mailing Address - Phone:330-993-0175
Mailing Address - Fax:
Practice Address - Street 1:479 STEPHENS RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2139
Practice Address - Country:US
Practice Address - Phone:330-993-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180596101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)