Provider Demographics
NPI:1124072970
Name:RYAN, JANICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:RYAN
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 1:1506 E FRANKLIN ST
Mailing Address - Street 2:#202
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2825
Mailing Address - Country:US
Mailing Address - Phone:919-968-0574
Mailing Address - Fax:919-929-0908
Practice Address - Street 1:1506 E FRANKLIN ST
Practice Address - Street 2:#202
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2825
Practice Address - Country:US
Practice Address - Phone:919-968-0574
Practice Address - Fax:919-929-0908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC74092OtherBC PROVIDER ID