Provider Demographics
NPI:1003544651
Name:BRYANT, KWATORIA LEKISHIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KWATORIA
Middle Name:LEKISHIA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BORDERS WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8967
Mailing Address - Country:US
Mailing Address - Phone:478-352-1026
Mailing Address - Fax:
Practice Address - Street 1:104 BORDERS WAY STE 500
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8967
Practice Address - Country:US
Practice Address - Phone:478-832-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional