Individual
JACOB ISRAEL RYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
200 MEDICAL DR, HAMPTON, VA 23666-1763
(757) 788-0200
Mailing address
300 MEDICAL DR, HAMPTON, VA 23666-1765
(757) 788-0300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103463
VA
101YP2500X
Professional Counselor
Primary
0701012308
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701012308
LICENSE
VA
01
—
0710103463
CSAC
VA
Enumeration date
07/05/2023
Last updated
07/05/2023
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