Provider Demographics
NPI:1932811593
Name:RYAN, CHRISTIANA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANA
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:MARIE
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1367 W HUBBARD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6475
Mailing Address - Country:US
Mailing Address - Phone:630-707-0614
Mailing Address - Fax:
Practice Address - Street 1:1142 W MADISON ST STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2191
Practice Address - Country:US
Practice Address - Phone:312-324-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional