Individual
RYAN ROSS ERVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
PO BOX 554, HILO, HI 96721-0554
(808) 755-3072
Mailing address
PO BOX 554, HILO, HI 96721-0554
(808) 755-3072
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
L11132
OR
1041C0700X
Clinical Social Worker
L11132
OR
1041C0700X
Clinical Social Worker
Primary
LCSW-5235
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500765374
—
OR
Enumeration date
06/24/2019
Last updated
12/09/2024
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