Provider Demographics
NPI:1225124175
Name:BRYANT, MARVIN M (MSW, LISW-CP)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2124
Mailing Address - Country:US
Mailing Address - Phone:803-776-7708
Mailing Address - Fax:803-776-0338
Practice Address - Street 1:1113 BELLEVIEW ST STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1839
Practice Address - Country:US
Practice Address - Phone:803-764-5377
Practice Address - Fax:803-764-4028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical