Provider Demographics
NPI:1932676608
Name:O'CONNOR, MATHEW RYAN (MA, LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:RYAN
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MA, LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6204
Mailing Address - Country:US
Mailing Address - Phone:919-906-4390
Mailing Address - Fax:
Practice Address - Street 1:3710 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6204
Practice Address - Country:US
Practice Address - Phone:919-906-4390
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21098101YA0400X
GALPC010427101YM0800X
COLPC.0014070101YM0800X
NC15233101YP2500X, 101YP2500X
NCA15233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty