Healthcare Provider Details

I. General information

NPI: 1629707070
Provider Name (Legal Business Name): TATIANA AALIYAH BRYANT M.ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BROOK RD
RICHMOND VA
23227-1338
US

IV. Provider business mailing address

3300 TUXEDO BLVD
RICHMOND VA
23223-5422
US

V. Phone/Fax

Practice location:
  • Phone: 804-553-3200
  • Fax:
Mailing address:
  • Phone: 804-591-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: