Provider Demographics
NPI:1659667707
Name:BRYANT, VINSON LEE (CADC, CCGC, TTS)
Entity Type:Individual
Prefix:MR
First Name:VINSON
Middle Name:LEE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:CADC, CCGC, TTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4826
Mailing Address - Country:US
Mailing Address - Phone:501-268-7777
Mailing Address - Fax:
Practice Address - Street 1:3204 E MOORE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4826
Practice Address - Country:US
Practice Address - Phone:501-268-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)