Healthcare Provider Details

I. General information

NPI: 1861130361
Provider Name (Legal Business Name): JESSICA BRYAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 COMMONWEALTH DR STE 101
CHARLOTTESVILLE VA
22901-1634
US

IV. Provider business mailing address

329 LYNNWOOD DR
BRISTOL VA
24201-1909
US

V. Phone/Fax

Practice location:
  • Phone: 434-214-6556
  • Fax:
Mailing address:
  • Phone: 276-492-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017261
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTH00947288
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: