Healthcare Provider Details

I. General information

NPI: 1104288737
Provider Name (Legal Business Name): ASHELY RYAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST SUITE 5
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

20 W BANK ST SUITE 5
PETERSBURG VA
23803-3279
US

V. Phone/Fax

Practice location:
  • Phone: 804-863-1689
  • Fax:
Mailing address:
  • Phone: 804-863-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: