Provider Demographics
NPI:1184883050
Name:VAN RYN, ANTOINETTE LENORE
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:LENORE
Last Name:VAN RYN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:LENORE
Other - Last Name:VAN RYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 E FESLER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4404
Mailing Address - Country:US
Mailing Address - Phone:805-922-6597
Mailing Address - Fax:
Practice Address - Street 1:115 E FESLER ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4404
Practice Address - Country:US
Practice Address - Phone:805-922-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)