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General NPI Number Information
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NPI Number | 1679206932
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Entity Type | Individual
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Provider Name | RYAN CHRISCOE
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Gender | Male
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 190 ROSEWOOD CENTRE DR STE 100
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7628
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Country | US
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Telephone | 919-851-1527
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Fax | 919-851-3555
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Provider Business Mailing Address
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Address Line | 108 PEAKHILL RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-8401
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Country | US
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Telephone | 919-753-7649
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A17733
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License Number State | NC
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