Provider Demographics
NPI:1104581982
Name:DAVIS, BRYONNA (LGPC)
Entity type:Individual
Prefix:
First Name:BRYONNA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 4TH ST SE APT 807
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2647
Mailing Address - Country:US
Mailing Address - Phone:804-873-4887
Mailing Address - Fax:
Practice Address - Street 1:9475 LOTTSFORD RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5346
Practice Address - Country:US
Practice Address - Phone:301-636-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional