# LIFE BALANCE CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811244858
- **Authorized official:** DR. ANNETTE BRYANT PHD-ABD, LCSW (OWNER/PROVIDER)
- **Authorized official phone:** (601) 831-4402

## Contact information

- **Practice address:** 1107 OPENWOOD ST, VICKSBURG, MS 39183
- **Practice address phone:** (601) 831-4402
- **Practice address fax:** (601) 206-0672
- **Mailing address:** 113 WOODSTONE DR, VICKSBURG, MS 39183-8319
- **Mailing address phone:** (601) 831-4402
- **Mailing address fax:** (601) 206-0672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C6582 | MS | Yes |

## Other

- **Enumeration date:** 08/09/2012
- **Last updated:** 08/07/2018