Provider Demographics
NPI:1346002177
Name:BRYANT, MONICA LORRAINE (MA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LORRAINE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4807
Mailing Address - Country:US
Mailing Address - Phone:404-375-7017
Mailing Address - Fax:
Practice Address - Street 1:1015 TYRONE RD STE 710
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2455
Practice Address - Country:US
Practice Address - Phone:770-468-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional