Provider Demographics
NPI:1194108316
Name:BRYANT-RATLIFF, TRINA (LGSW)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:BRYANT-RATLIFF
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215A STEWART PLZ
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3021
Mailing Address - Country:US
Mailing Address - Phone:304-542-7747
Mailing Address - Fax:304-768-5508
Practice Address - Street 1:1215A STEWART PLZ
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3021
Practice Address - Country:US
Practice Address - Phone:304-542-7747
Practice Address - Fax:304-768-5508
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP009429531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical