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General NPI Number Information
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NPI Number | 1982345633
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Entity Type | Individual
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Provider Name | VICTORIA JACQUELINE BRYANT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 1122 HIGHWAY 91 APT A
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City | ELIZABETHTON
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State | TN
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Zip | 37643-6226
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Country | US
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Telephone | 423-492-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 HIGHWAY 91 APT A
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City | ELIZABETHTON
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State | TN
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Zip | 37643-6226
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Country | US
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Telephone | 423-492-3087
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5827
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License Number State | TN
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