Provider Demographics
NPI:1598322307
Name:BRYANT-CONNER, SHARI LE (CDCI, NCACI)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LE
Last Name:BRYANT-CONNER
Suffix:
Gender:F
Credentials:CDCI, NCACI
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:LE
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCI,NCACI
Mailing Address - Street 1:34265 MATANUSKA ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9490
Mailing Address - Country:US
Mailing Address - Phone:907-252-5286
Mailing Address - Fax:
Practice Address - Street 1:245 N BINKLEY ST STE 202
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7500
Practice Address - Country:US
Practice Address - Phone:907-714-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4156101YA0400X
AK016825101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)