Provider Demographics
NPI:1508985482
Name:O'BRYANT, JANICE PEPPER (MS, LPA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:PEPPER
Last Name:O'BRYANT
Suffix:
Gender:F
Credentials:MS, LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 OLD LAMPLIGHTER WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3430
Mailing Address - Country:US
Mailing Address - Phone:910-313-1776
Mailing Address - Fax:
Practice Address - Street 1:5710 OLEANDER DR STE 112
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4722
Practice Address - Country:US
Practice Address - Phone:910-769-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2945101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2945OtherLPC LICENSE
NC2121OtherLICENSED PSYCHOLOGICAL AS
NC6107047Medicaid