Healthcare Provider Details

I. General information

NPI: 1598322307
Provider Name (Legal Business Name): SHARI LE BRYANT-CONNER CDCI, NCACI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARI LE CONNER CDCI,NCACI

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

34265 MATANUSKA ST
SOLDOTNA AK
99669-9490
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax:
Mailing address:
  • Phone: 907-252-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4156
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number016825
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: