Healthcare Provider Details

I. General information

NPI: 1316644065
Provider Name (Legal Business Name): RYAN LEIGH SYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2966 FOREST HILLS RD
PETERSBURG VA
23805-2665
US

IV. Provider business mailing address

2966 FOREST HILLS RD
PETERSBURG VA
23805-2665
US

V. Phone/Fax

Practice location:
  • Phone: 804-943-7827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: