| Doctor Name: | NICOLET KIM RYAN |
| NPI Number: | 1235155052 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW-CP |
| License Number: | 8648 |
| Business Practice Address: | 100 Sutter Dr Suite 305 Surfside Beach, SC - 295758665 |
| Business Phone Number: | 8438550035 |
| Business Fax Number: | |
| Mailing Address: | Po Box 31738, MYRTLE BEACH |
| State: | SC |
| Postal Code: | 295880029 |
| Phone Number: | 8438550035 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 8648 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |