Provider Demographics
NPI:1114275591
Name:BRYANT, CHIQUANA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:CHIQUANA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4196
Mailing Address - Country:US
Mailing Address - Phone:252-695-0269
Mailing Address - Fax:
Practice Address - Street 1:1202 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4196
Practice Address - Country:US
Practice Address - Phone:252-695-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical