Individual
CHARISMA BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12531 CLIPPER DR STE 203, WOODBRIDGE, VA 22192-2355
(571) 398-0428
Mailing address
12531 CLIPPER DR STE 203, WOODBRIDGE, VA 22192-2355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97153
—
VA
Enumeration date
01/25/2023
Last updated
01/25/2023
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