Provider Demographics
NPI:1548565559
Name:BRYANT, DEIDRE (MS, CSAC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W BROOKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 W BROOKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2515
Practice Address - Country:US
Practice Address - Phone:540-455-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102172101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)