Provider Demographics
NPI:1376829804
Name:LASURE-BRYANT, DANIELLE (EDD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LASURE-BRYANT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 OLD EMMORTON ROAD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-569-9497
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:11600 CEDARVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613
Practice Address - Country:US
Practice Address - Phone:410-569-9497
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional