Provider Demographics
NPI:1003471038
Name:BRYANT, SHEENA (MS, MAC, CAC II)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, MAC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 HIGHWAY 42 N STE C
Mailing Address - Street 2:
Mailing Address - City:JENKINSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30234-2461
Mailing Address - Country:US
Mailing Address - Phone:770-504-3340
Mailing Address - Fax:
Practice Address - Street 1:2093 HIGHWAY 42 N STE C
Practice Address - Street 2:
Practice Address - City:JENKINSBURG
Practice Address - State:GA
Practice Address - Zip Code:30234-2461
Practice Address - Country:US
Practice Address - Phone:770-504-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)