Healthcare Provider Details

I. General information

NPI: 1801400270
Provider Name (Legal Business Name): KATHRYN J RYDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HUBBARD ST
BLACKSBURG VA
24060-5724
US

IV. Provider business mailing address

100 HUBBARD ST
BLACKSBURG VA
24060-5724
US

V. Phone/Fax

Practice location:
  • Phone: 540-200-8972
  • Fax:
Mailing address:
  • Phone: 540-200-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701004544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: