MEDICARE: DR. RYAN ROBERT ADAMCZYK PH.D., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	9247	NC
2	101YM0800X	Mental Health Counselor	9247	NC

General Provider Information

NPI Number	:	1528305588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ROBERT ADAMCZYK PH.D., LPC

Provider Business Mailing Address
First Line	:	8401 MEDICAL PLAZA DR STE 360
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-8700
Country	:	US
Telephone Number	:	704-208-4458
Fax Number	:	866-309-6385

Provider Business Practice Location Address
First Line	:	8401 MEDICAL PLAZA DR STE 360
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-8700
Country	:	US
Telephone Number	:	704-208-4458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	08/15/2019

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