Provider Demographics
NPI:1598647570
Name:BRYANT, DESHAWNA
Entity type:Individual
Prefix:
First Name:DESHAWNA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 WINNER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5148
Mailing Address - Country:US
Mailing Address - Phone:443-257-1940
Mailing Address - Fax:
Practice Address - Street 1:10 W MADISON ST STE 11
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2313
Practice Address - Country:US
Practice Address - Phone:443-438-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health