Provider Demographics
NPI:1679859490
Name:BRYANT, ERICA CELESTE (BS, MHPP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:CELESTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:BS, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:3601 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2954
Practice Address - Country:US
Practice Address - Phone:501-221-1843
Practice Address - Fax:501-221-2376
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator