Provider Demographics
NPI:1285058024
Name:BRYANT HAGAN, SAMANDA (PHD, LCSW, MDIV)
Entity type:Individual
Prefix:DR
First Name:SAMANDA
Middle Name:
Last Name:BRYANT HAGAN
Suffix:
Gender:F
Credentials:PHD, LCSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP BLDG 4554
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:404-630-6844
Mailing Address - Fax:
Practice Address - Street 1:4538 CENTERVIEW STE 180
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1319
Practice Address - Country:US
Practice Address - Phone:726-201-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX661181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical