Provider Demographics
NPI:1588185441
Name:RYAN, LISA LASHONNE (RAS, CATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LASHONNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RAS, CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-2330
Mailing Address - Country:US
Mailing Address - Phone:510-677-8958
Mailing Address - Fax:510-839-6775
Practice Address - Street 1:2811 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4409
Practice Address - Country:US
Practice Address - Phone:510-874-7850
Practice Address - Fax:510-839-6775
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)