Provider Demographics
NPI:1558034231
Name:BRYAN, CAROLINE SUZANNE (APCC, AMFT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUZANNE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:APCC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SOLANO SQ # 240
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2712
Mailing Address - Country:US
Mailing Address - Phone:707-567-8007
Mailing Address - Fax:
Practice Address - Street 1:1 QUALITY DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9494
Practice Address - Country:US
Practice Address - Phone:707-624-2830
Practice Address - Fax:707-624-2831
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC7925101YM0800X
CAAMFT116914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health