| Doctor Name: | DANIELLE LASURE-BRYANT |
| NPI Number: | 1376829804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.D. |
| License Number: | LC3163 |
| Business Practice Address: | 11600 Cedarville Road Brandywine, MD - 20613 |
| Business Phone Number: | 4105699497 |
| Business Fax Number: | 4105690094 |
| Mailing Address: | 2227 Old Emmorton Road, Suite 119 BEL AIR |
| State: | MD |
| Postal Code: | 21015 |
| Phone Number: | 4105699497 |
| Fax Number: | 4105690094 |
| NPI Enumeration Date: | 10/28/2011 |
| NPI Last Update Date: | 10/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC3163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |