Provider Demographics
NPI:1689344210
Name:PETERSON, RYANNE (LCMHC)
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S MANGUM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4689
Mailing Address - Country:US
Mailing Address - Phone:984-377-3620
Mailing Address - Fax:
Practice Address - Street 1:555 S MANGUM ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4689
Practice Address - Country:US
Practice Address - Phone:984-377-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health