Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LC7967 | MD |
N | 101YP1600X | Pastoral Counselor | LC7967 | MD |
NPI | 1033605878 |
---|---|
Provider Name | Briah Leslie Ryan |
First Address | Odenton, MD 21113 |
Second Address | Severna Park, MD 21146-4716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |