Individual
LATORJA J O'BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
3523 CRAWFORDVILLE DR, AUGUSTA, GA 30909-9437
(706) 589-3414
(706) 481-6791
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
MSW003517
GA
1041C0700X
Clinical Social Worker
Primary
CSW004597
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606317B
—
GA
Enumeration date
12/12/2005
Last updated
01/17/2014
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