Individual
ROBERTA D. BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP, AAC, CPC
Contact information
Practice address
1956 NE KRESKY AVE, CHEHALIS, WA 98532-2307
(360) 740-4380
Mailing address
PO BOX 59, CHEHALIS, WA 98532-0059
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60956223
WA
175T00000X
Peer Specialist
CG60505628
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2130811
—
WA
Enumeration date
03/29/2019
Last updated
05/04/2023
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