Provider Demographics
NPI:1326784968
Name:BRYANT, PAULETTE KAY (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:KAY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 HOWELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-3409
Mailing Address - Country:US
Mailing Address - Phone:251-423-8896
Mailing Address - Fax:
Practice Address - Street 1:288 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4204
Practice Address - Country:US
Practice Address - Phone:228-388-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL191081041C0700X
FLSW191081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical