Provider Demographics
NPI:1154914828
Name:BRYAN, BRIANNA MONAE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MONAE
Last Name:BRYAN
Suffix:
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 1:8547 WINTER OAKS LN APT 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5570
Mailing Address - Country:US
Mailing Address - Phone:704-589-8242
Mailing Address - Fax:
Practice Address - Street 1:8547 WINTER OAKS LN APT 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5570
Practice Address - Country:US
Practice Address - Phone:704-589-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician