Provider Demographics
NPI:1356102586
Name:AYERS, RYAN KENT
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENT
Last Name:AYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 PEWTER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6419
Mailing Address - Country:US
Mailing Address - Phone:843-501-5740
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNHAVEN PKWY STE 340
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7361
Practice Address - Country:US
Practice Address - Phone:843-501-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060149901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical