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General NPI Number Information
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NPI Number | 1518216290
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Entity Type | Individual
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Provider Name | QUINICKA BRYANT-GHANT MSW, BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 1237 AUGUSTA AVE
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City | AUGUSTA
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State | GA
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Zip | 30901-3201
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Country | US
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Telephone | 762-685-4340
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Fax | 762-585-9965
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Provider Business Mailing Address
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Address Line | 300 INTERNATIONAL PKWY STE 200
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City | LAKE MARY
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State | FL
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Zip | 32746-5028
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Country | US
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Telephone | 866-610-0580
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Fax | 407-588-6294
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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