Healthcare Provider Details

I. General information

NPI: 1801112123
Provider Name (Legal Business Name): PAMELA R. BRYANT, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 GLENSIDE DR STE B
RICHMOND VA
23228-3995
US

IV. Provider business mailing address

5412 GLENSIDE DR STE B
RICHMOND VA
23228-3995
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-4300
  • Fax:
Mailing address:
  • Phone: 804-741-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003425
License Number StateVA

VIII. Authorized Official

Name: MS. PAMELA RATHBUN BRYANT
Title or Position: OWNER
Credential: LCSW
Phone: 804-741-4300