person
Jacob Israel Ryder, LPC
Addiction (Substance Use Disorder) Counselor in Hampton, Virginia
NPI 1104504794

Jacob Israel Ryder is an Addiction (Substance Use Disorder) Counselor based in Hampton, VA and is specialized in Addiction (Substance Use Disorder). Jacob Israel Ryder practices in Hampton, VA and has the professional credentials of LPC. The NPI Number for Jacob Israel Ryder is 1104504794 and holds a License No. 0701012308 (Virginia).

The current practice location address for Jacob Israel Ryder is 200 Medical Dr, Hampton, VA and can be reached out via phone at 757-788-0200.

Location: 200 Medical Dr, Hampton, VA, 23666-1765
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Provider Profile Details
NPI Number
1104504794
Provider Name
Jacob Israel Ryder
Credential
LPC
Provider Entity Type
Individual
Gender
Male
Address
200 Medical Dr, Hampton, VA, 23666-1765
Phone Number
757-788-0200
Fax Number
Provider Enumeration Date
07/05/2023
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0710103463 01 VA CSAC
0701012308 01 VA LICENSE
institution
Provider Business Practice Location Address Details
Address
200 Medical Dr
City
State
Zip
23666-1763
Phone Number
757-788-0200
Fax Number
person
Provider Business Mailing Address Details
Address
200 Medical Dr
City
State
Zip
23666-1763
Phone Number
757-788-0200
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
0710103463 (Virginia)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
0701012308 (Virginia)
Definition
Definition to come...
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