Healthcare Provider Details

I. General information

NPI: 1356687297
Provider Name (Legal Business Name): RYAN T. GREENE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 PETERS CREEK RD NW BLDG 3
ROANOKE VA
24017-2506
US

IV. Provider business mailing address

1316 MEADOWVIEW DR
SALEM VA
24153-6684
US

V. Phone/Fax

Practice location:
  • Phone: 540-355-8300
  • Fax:
Mailing address:
  • Phone: 540-355-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005341
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0701005341
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005341
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701005341
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: