Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCI10290118 | CA |
NPI | 1003935404 |
---|---|
Provider Name | Roland Bradford Bryant |
First Address | San Diego, CA 92102-3296 |
Second Address | San Diego, CA 92102-3241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 18/09/2018 |