Provider Demographics
NPI:1417352642
Name:BRYANT, ANITA MICHELLE (LCAS, CADC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MICHELLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCAS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 GLEN VERDE TRL APT 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4250
Mailing Address - Country:US
Mailing Address - Phone:919-330-3840
Mailing Address - Fax:
Practice Address - Street 1:10520 LIGON MILL RD STE 100A
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4586
Practice Address - Country:US
Practice Address - Phone:919-330-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist