Provider Demographics
NPI:1922533694
Name:BRYANT, DIANA (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 OSCAR FRYE RD
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-8269
Mailing Address - Country:US
Mailing Address - Phone:336-408-9526
Mailing Address - Fax:
Practice Address - Street 1:153 JEFFERSON CHURCH RD STE E
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8605
Practice Address - Country:US
Practice Address - Phone:336-448-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10097A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist