Provider Demographics
NPI:1578664090
Name:BRYANT, SANDRA O (LPC,RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:O
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 LANGHORNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1121
Mailing Address - Country:US
Mailing Address - Phone:434-455-3047
Mailing Address - Fax:434-948-4918
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-455-3047
Practice Address - Fax:434-948-4918
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002573101YP2500X
VA0717000669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA243077OtherANTHEM
VA004945441Medicaid