Healthcare Provider Details

I. General information

NPI: 1689183873
Provider Name (Legal Business Name): RYAN ROSEWELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 01/09/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W MAIN ST STE 100
ABINGDON VA
24210-2608
US

IV. Provider business mailing address

150 LINDEN AVE
LYNCHBURG VA
24503-2010
US

V. Phone/Fax

Practice location:
  • Phone: 833-356-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: