Provider Demographics
NPI:1427611250
Name:DYAR, BRANDANCE G (P-LPC)
Entity type:Individual
Prefix:
First Name:BRANDANCE
Middle Name:G
Last Name:DYAR
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E LAMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2909
Mailing Address - Country:US
Mailing Address - Phone:662-338-1880
Mailing Address - Fax:844-270-2703
Practice Address - Street 1:309 E LAMPKIN ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2909
Practice Address - Country:US
Practice Address - Phone:662-338-1880
Practice Address - Fax:844-270-2703
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP-0182OtherP-LPC