Provider Demographics
NPI:1689752248
Name:BRYANT, DIANNE III
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:BRYANT
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PIEDMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1835
Mailing Address - Country:US
Mailing Address - Phone:803-329-3177
Mailing Address - Fax:803-329-3319
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4541
Practice Address - Country:US
Practice Address - Phone:803-328-9600
Practice Address - Fax:803-329-7141
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health