Healthcare Provider Details

I. General information

NPI: 1356079834
Provider Name (Legal Business Name): CLARISSA LASHEA BRYANT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 HARBOR VIEW BLVD STE 101
SUFFOLK VA
23435-2762
US

IV. Provider business mailing address

7025 HARBOR VIEW BLVD STE 101
SUFFOLK VA
23435-2762
US

V. Phone/Fax

Practice location:
  • Phone: 757-292-4774
  • Fax: 757-292-4774
Mailing address:
  • Phone: 757-292-4774
  • Fax: 757-292-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002637
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: