Individual
KHALLIAH GRACE BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1009 MAITLAND CENTER COMMONS BLVD STE 212, MAITLAND, FL 32751-7270
(800) 840-2528
Mailing address
3634 BOONE PARK AVE UNIT 2, JACKSONVILLE, FL 32205-9002
(229) 256-3123
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/30/2017
Last updated
08/30/2017
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