Provider Demographics
NPI:1467462960
Name:BRYANT, DAVID RONALD (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RONALD
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141
Mailing Address - Country:US
Mailing Address - Phone:540-731-0838
Mailing Address - Fax:540-731-3375
Practice Address - Street 1:200 8TH ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141
Practice Address - Country:US
Practice Address - Phone:540-731-0838
Practice Address - Fax:540-731-3375
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
510536OtherVALUE OPTIONS
VA5413346Medicaid