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NPI Code Detail

MEDICARE: LAVERNE NICHOLE BRYANT

MEDICARE: LAVERNE NICHOLE BRYANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0704016056VA
2101YM0800XMental Health Counselor0704016056VA

General Provider Information

NPI Number : 1093497927
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAVERNE NICHOLE BRYANT
Provider Business Mailing Address
First Line : 501 VILLAGE AVE STE 204
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-5657
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 VILLAGE AVE
Second Line : STE 204
City : YORKTOWN
State : VA
Zip : 23693-5657
Country : US
Telephone Number : 757-568-5904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2023
Last Update Date : 08/01/2023

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Directions to “ LAVERNE NICHOLE BRYANT ” Practice Location

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