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Individual
JACK RYAN
Active
Individual
JACK RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0008885
CT
101YP2500X
Professional Counselor
Primary
003589
CT
Other
Enumeration date
11/13/2008
Last updated
02/08/2019
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