Individual
JACK RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, LPC
Contact information
Practice address
2475 ALBANY AVE STE 203B, WEST HARTFORD, CT 06117-2523
(860) 519-6492
(860) 519-6492
Mailing address
53 MANOR LN, SOUTH WINDSOR, CT 06074-3214
(860) 519-6492
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0008885
CT
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
003589
CT
Other
Enumeration date
11/13/2008
Last updated
02/08/2019
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