Provider Demographics
NPI:1528755394
Name:AUSTIN, RYAN WILLIAM (LPC, NCC, MS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WOODSTREAM WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2487
Mailing Address - Country:US
Mailing Address - Phone:214-930-7626
Mailing Address - Fax:
Practice Address - Street 1:2033 HOSEA L WILLIAMS DR NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2501
Practice Address - Country:US
Practice Address - Phone:214-930-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008712101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor