Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | GA |
NPI | 1003471038 |
---|---|
Provider Name | Sheena Bryant |
First Address | Jenkinsburg, GA 30234-2461 |
Second Address | Jenkinsburg, GA 30234-2461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 06/05/2019 |