Provider Demographics
NPI:1568136372
Name:TROTMAN, BRYAN JOSEPH
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOSEPH
Last Name:TROTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 COLLEY AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2166
Mailing Address - Country:US
Mailing Address - Phone:757-629-4352
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE STE 122
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2166
Practice Address - Country:US
Practice Address - Phone:757-629-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA376905001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health