Provider Demographics
NPI:1982982781
Name:RYAN, DEMARCO RESHARD (DEMARCO RYAN)
Entity Type:Individual
Prefix:MR
First Name:DEMARCO
Middle Name:RESHARD
Last Name:RYAN
Suffix:
Gender:M
Credentials:DEMARCO RYAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHACE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4491
Mailing Address - Country:US
Mailing Address - Phone:864-227-1964
Mailing Address - Fax:
Practice Address - Street 1:811 CHACE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4491
Practice Address - Country:US
Practice Address - Phone:864-227-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst