Provider Demographics
NPI:1437801768
Name:BRYANT, MAWAH
Entity Type:Individual
Prefix:
First Name:MAWAH
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 PATTERSON AVE APT 146
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6122
Mailing Address - Country:US
Mailing Address - Phone:804-402-4310
Mailing Address - Fax:
Practice Address - Street 1:9001 PATTERSON AVE APT 146
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6122
Practice Address - Country:US
Practice Address - Phone:804-402-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health