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Organization
LIFE BALANCE CLINIC LLC
Active
Organization
LIFE BALANCE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNETTE BRYANT PHD-ABD, LCSW (OWNER/PROVIDER)
(601) 831-4402
Entity
Organization
Contact information
Practice address
1107 OPENWOOD ST, VICKSBURG, MS 39183
(601) 831-4402
(601) 206-0672
Mailing address
113 WOODSTONE DR, VICKSBURG, MS 39183-8319
(601) 831-4402
(601) 206-0672
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6582
MS
Other
Enumeration date
08/09/2012
Last updated
08/07/2018
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