Provider Demographics
NPI:1780810762
Name:SMITH, RYAN (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12438
Mailing Address - Street 2:
Mailing Address - City:RTP
Mailing Address - State:NC
Mailing Address - Zip Code:27709-2438
Mailing Address - Country:US
Mailing Address - Phone:919-674-2382
Mailing Address - Fax:
Practice Address - Street 1:3800 PARAMOUNT PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6949
Practice Address - Country:US
Practice Address - Phone:919-674-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional