MEDICARE: SAMANTHA LOREN RYAN MSW, LCSWA, LCASA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-30221	NC
2	101YM0800X	Mental Health Counselor	P021293	NC

General Provider Information

NPI Number	:	1831057645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LOREN RYAN MSW, LCSWA, LCASA

Provider Business Mailing Address
First Line	:	211 S TRADD ST
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-5859
Country	:	US
Telephone Number	:	828-655-2930
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S TRADD ST
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-5859
Country	:	US
Telephone Number	:	828-655-2930
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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