Provider Demographics
NPI:1689326878
Name:YARBROUGH, RYENN NICOLE JOHNS
Entity Type:Individual
Prefix:
First Name:RYENN
Middle Name:NICOLE JOHNS
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 RIFLE RANGE RD APT 9F
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4636
Mailing Address - Country:US
Mailing Address - Phone:913-709-8697
Mailing Address - Fax:
Practice Address - Street 1:1053 RIFLE RANGE RD APT 9F
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4636
Practice Address - Country:US
Practice Address - Phone:913-709-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor