Provider Demographics
NPI:1124272471
Name:RYBARCZYK, NENA (LPC, NCC, CPCS, DCC)
Entity type:Individual
Prefix:MS
First Name:NENA
Middle Name:
Last Name:RYBARCZYK
Suffix:
Gender:F
Credentials:LPC, NCC, CPCS, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N TENNESSEE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7937
Mailing Address - Country:US
Mailing Address - Phone:770-722-7040
Mailing Address - Fax:
Practice Address - Street 1:1124 N TENNESSEE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-7937
Practice Address - Country:US
Practice Address - Phone:770-722-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006876101YP2500X, 101YM0800X
103K00000X, 101YA0400X, 101Y00000X, 106H00000X
GA006876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003131489AMedicaid