Provider Demographics
NPI:1639245673
Name:TERRELL, RYAN E (MA)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:E
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:RYAN
Other - Middle Name:E
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8702
Mailing Address - Country:US
Mailing Address - Phone:843-745-5153
Mailing Address - Fax:843-766-8606
Practice Address - Street 1:1483 TOBIAS GADSON BLVD
Practice Address - Street 2:STE 107
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-8702
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:843-766-8606
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health