Healthcare Provider Details

I. General information

NPI: 1003458753
Provider Name (Legal Business Name): RISA BYARS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VICTORY POINT DR
BLUFFTON SC
29910-6127
US

IV. Provider business mailing address

65 VICTORY POINT DR
BLUFFTON SC
29910-6127
US

V. Phone/Fax

Practice location:
  • Phone: 843-345-7294
  • Fax:
Mailing address:
  • Phone: 843-345-7294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: RISA BYARS
Title or Position: OWNER
Credential: PSYD
Phone: 843-345-7294