Provider Demographics
NPI:1558511766
Name:BRYANT, CAMILLE ANNETTE (BS)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ANNETTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3132
Mailing Address - Country:US
Mailing Address - Phone:931-490-1460
Mailing Address - Fax:
Practice Address - Street 1:321 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3132
Practice Address - Country:US
Practice Address - Phone:931-490-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62-1674308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor