Provider Demographics
NPI:1053117143
Name:BRYAN, CAROLINE M (LPC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:BRYAN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HUDDERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4071
Mailing Address - Country:US
Mailing Address - Phone:804-615-5004
Mailing Address - Fax:
Practice Address - Street 1:8350 N CENTRAL EXPY STE 1275
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1614
Practice Address - Country:US
Practice Address - Phone:804-615-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12694225A00000X
89630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist