Doctor Name: | KIMBERLY B BRYD |
NPI Number: | 1306125786 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 0701005092 |
Business Practice Address: | 770 W Ridge Rd Wytheville, VA - 243821187 |
Business Phone Number: | 2762233200 |
Business Fax Number: | 2762230617 |
Mailing Address: | 770 W Ridge Rd, WYTHEVILLE |
State: | VA |
Postal Code: | 243821187 |
Phone Number: | 2762233200 |
Fax Number: | 2762230617 |
NPI Enumeration Date: | 08/16/2011 |
NPI Last Update Date: | 08/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701005092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |