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General NPI Number Information
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NPI Number | 1225124175
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Entity Type | Individual
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Provider Name | MARVIN M BRYANT MSW, LISW-CP
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1113 BELLEVIEW ST STE 101
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City | COLUMBIA
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State | SC
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Zip | 29201-1839
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Country | US
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Telephone | 803-764-5377
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Fax | 803-764-4028
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Provider Business Mailing Address
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Address Line | 1006 KENMORE DR
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City | COLUMBIA
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State | SC
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Zip | 29209-2124
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Country | US
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Telephone | 803-776-7708
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Fax | 803-776-0338
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4418
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License Number State | SC
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