Provider Demographics
NPI:1467029249
Name:RYAN, CORA M (PHD, HSP-P)
Entity type:Individual
Prefix:DR
First Name:CORA
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD, HSP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233A MERCHANTS CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-5419
Mailing Address - Country:US
Mailing Address - Phone:910-406-1027
Mailing Address - Fax:
Practice Address - Street 1:233A MERCHANTS CIR STE 204
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-5419
Practice Address - Country:US
Practice Address - Phone:910-406-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist