Provider Demographics
NPI:1912720392
Name:WHITE, RYAN (LPC, LCMHC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4733
Mailing Address - Country:US
Mailing Address - Phone:336-317-2473
Mailing Address - Fax:
Practice Address - Street 1:1707 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4733
Practice Address - Country:US
Practice Address - Phone:336-317-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20490101YM0800X
VA0701011316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health