Provider Demographics
NPI:1821678772
Name:PATRICK, RYAN FRANCIS (LMSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:FRANCIS
Last Name:PATRICK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:FRANCIS
Other - Middle Name:EVELYN
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 MOUNTBURY CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2545
Mailing Address - Country:US
Mailing Address - Phone:678-506-1175
Mailing Address - Fax:
Practice Address - Street 1:809 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1870
Practice Address - Country:US
Practice Address - Phone:404-954-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker