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General NPI Number Information
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NPI Number | 1962019869
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Entity Type | Individual
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Provider Name | GISELLE REMY-BRYAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 12 EXECUTIVE PARK DR NE STE 300
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City | ATLANTA
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State | GA
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Zip | 30329-2206
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Country | US
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Telephone | 404-778-0669
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Fax | 404-712-1913
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Provider Business Mailing Address
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Address Line | 12 EXECUTIVE PARK DR NE STE 300
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City | ATLANTA
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State | GA
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Zip | 30329-2206
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Country | US
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Telephone | 404-778-0669
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Fax | 404-712-1913
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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 | CSW007241
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License Number State | GA
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