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General NPI Number Information
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NPI Number | 1093407843
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Entity Type | Individual
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Provider Name | CHRISTA RYAN CADC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 8 KILBURN ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-7321
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Country | US
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Telephone | 508-979-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 1399 PHILLIPS RD APT 32
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City | NEW BEDFORD
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State | MA
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Zip | 02745-1939
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Country | US
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Telephone | 774-269-3589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1935AD
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License Number State | MA
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