Provider Demographics
NPI:1477041937
Name:BRYANT, ANNA VANDENBERG (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VANDENBERG
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CAROL
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5490 HIGHTOWER TRL SE
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4632
Mailing Address - Country:US
Mailing Address - Phone:770-826-2901
Mailing Address - Fax:
Practice Address - Street 1:5490 HIGHTOWER TRL SE
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-4632
Practice Address - Country:US
Practice Address - Phone:770-826-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional