Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MT2178 | FL |
N | 101YS0200X | School Counselor | MT2178 | FL |
NPI | 1013207299 |
---|---|
Provider Name | Mrs. Lori L Bryant |
First Address | Roswell, GA 30076-5835 |
Second Address | Roswell, GA 30076-5835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2011 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013207299 | TRICARE (01) |