Individual
BRYANT L DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149027162
IL
Other
Enumeration date
04/24/2024
Last updated
07/18/2024
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