Healthcare Provider Details

I. General information

NPI: 1912423583
Provider Name (Legal Business Name): DONYETTA CALHOUN BRYSON ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 AZALEA AVE
RICHMOND VA
23227-3634
US

IV. Provider business mailing address

PO BOX 23120
RICHMOND VA
23223-0420
US

V. Phone/Fax

Practice location:
  • Phone: 804-228-2710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000891
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: