Provider Demographics
NPI:1164165502
Name:FRYANT, MARISUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISUSAN
Middle Name:
Last Name:FRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GREATLAND FARM DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-3543
Mailing Address - Country:US
Mailing Address - Phone:540-878-0799
Mailing Address - Fax:
Practice Address - Street 1:209 GREATLAND FARM DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-3543
Practice Address - Country:US
Practice Address - Phone:540-878-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0148831041C0700X
VA09040137381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical