Provider Demographics
NPI:1093966905
Name:BRYANT, KARENMARIE (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:KARENMARIE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 BARNFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5113
Mailing Address - Country:US
Mailing Address - Phone:919-556-6789
Mailing Address - Fax:
Practice Address - Street 1:1045 BARNFORD MILL RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5113
Practice Address - Country:US
Practice Address - Phone:919-556-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC434101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)