Healthcare Provider Details

I. General information

NPI: 1619677010
Provider Name (Legal Business Name): CHRISTINE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MLK JR. AVE SE
WASHINGTON DC
20020
US

IV. Provider business mailing address

1879 ALABAMA AVE SE
WASHINGTON DC
20020-2874
US

V. Phone/Fax

Practice location:
  • Phone: 202-760-7492
  • Fax:
Mailing address:
  • Phone: 202-582-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG20004751
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: