Healthcare Provider Details

I. General information

NPI: 1932676608
Provider Name (Legal Business Name): MATHEW RYAN O'CONNOR MA, LCMHC, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

IV. Provider business mailing address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-4390
  • Fax: 828-544-1201
Mailing address:
  • Phone: 919-906-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0014070
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15233
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21098
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC010427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: