Provider Demographics
NPI:1558536102
Name:RYAN, JAMES M (LCPC LCADC CRC CDMS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCPC LCADC CRC CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19630 CLUB HOUSE RD STE 715
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3040
Mailing Address - Country:US
Mailing Address - Phone:301-258-7771
Mailing Address - Fax:301-258-9078
Practice Address - Street 1:19630 CLUB HOUSE RD STE 715
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-258-7771
Practice Address - Fax:301-258-9078
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1361101YM0800X
MDLCA372101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCA372OtherMD STATE LINCENSE