Provider Demographics
NPI:1386919231
Name:RICKS, JONATHAN RYAN (PHD, MA, LCMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:RICKS
Suffix:
Gender:M
Credentials:PHD, MA, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 HAWKS RD
Mailing Address - Street 2:
Mailing Address - City:NORLINA
Mailing Address - State:NC
Mailing Address - Zip Code:27563-9794
Mailing Address - Country:US
Mailing Address - Phone:252-203-1317
Mailing Address - Fax:
Practice Address - Street 1:238 HAWKS RD
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9794
Practice Address - Country:US
Practice Address - Phone:252-456-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9307101YM0800X
NC9308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health