Provider Demographics
NPI:1699596809
Name:BRYANT, VICTORIA ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:118 DANIEL HESTER RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:GA
Mailing Address - Zip Code:31637-6447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 DANIEL HESTER RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:GA
Practice Address - Zip Code:31637-6447
Practice Address - Country:US
Practice Address - Phone:229-237-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker