Healthcare Provider Details

I. General information

NPI: 1548681919
Provider Name (Legal Business Name): RYAN DUNLEVY LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ANDREWS RD SUITE 103
DURHAM NC
27705-2993
US

IV. Provider business mailing address

1613 NETHERFIELD LN
RALEIGH NC
27610-4536
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-5777
  • Fax:
Mailing address:
  • Phone: 336-706-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA10558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: