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General NPI Number Information
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NPI Number | 1053117143
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Entity Type | Individual
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Provider Name | CAROLINE M BRYAN LPC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 8350 N CENTRAL EXPY STE 1275
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City | DALLAS
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State | TX
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Zip | 75206-1614
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Country | US
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Telephone | 804-615-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 118 HUDDERSFIELD DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-4071
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Country | US
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Telephone | 804-615-5004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 12694
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 89630
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License Number State |
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