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General NPI Number Information
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NPI Number | 1205394160
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Entity Type | Organization
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Legal Business Name | NATALIE BRYAN, LCSW L.L.C.
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 104 GREENE ST
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City | AUGUSTA
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State | GA
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Zip | 30901-1609
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Country | US
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Telephone | 762-585-4610
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Fax | 708-884-1454
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Provider Business Mailing Address
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Address Line | 2140 RESERVE LN
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City | AUGUSTA
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State | GA
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Zip | 30907-6218
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Country | US
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Telephone | 516-610-8720
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NATALIE BRYAN
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Credential | LCSW
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Telephone | 516-610-8720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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