Individual
MRS. ANNETTE BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1107 OPENWOOD ST, VICKSBURG, MS 39183
(601) 831-4402
(601) 206-0672
Mailing address
113 WOODSTONE DR, VICKSBURG, MS 39183-8319
(601) 831-4402
(601) 206-0672
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6582
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08000025
—
MS
01
—
302I801727
MEDICARE PTAN
MS
Enumeration date
07/24/2006
Last updated
08/06/2018
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