Provider Demographics
NPI:1326478132
Name:BRYANT, SHAMONA DYANNA (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:SHAMONA
Middle Name:DYANNA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1118
Mailing Address - Country:US
Mailing Address - Phone:269-323-1954
Mailing Address - Fax:
Practice Address - Street 1:5805 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1118
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health