Provider Demographics
NPI:1629898515
Name:RYALS, BECKY L (LCSW)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:RYALS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 HARVEST TURN LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3498
Mailing Address - Country:US
Mailing Address - Phone:847-207-4467
Mailing Address - Fax:
Practice Address - Street 1:3060 KIMBALL BRIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1404
Practice Address - Country:US
Practice Address - Phone:404-388-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor