Provider Demographics
NPI:1235547852
Name:BRYAN, COBY (LCSW)
Entity Type:Individual
Prefix:
First Name:COBY
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 PEACHTREE ST NW STE 415
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7022
Mailing Address - Country:US
Mailing Address - Phone:678-751-4789
Mailing Address - Fax:
Practice Address - Street 1:1708 PEACHTREE ST NW STE 415
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7022
Practice Address - Country:US
Practice Address - Phone:678-751-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0061681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical