Provider Demographics
NPI:1538303102
Name:BRYANT, JANICE L (MS, LPC, LCAS)
Entity Type:Individual
Prefix:MISS
First Name:JANICE
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 HIGHGATE DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6622
Mailing Address - Country:US
Mailing Address - Phone:919-544-1300
Mailing Address - Fax:919-544-1331
Practice Address - Street 1:5317 HIGHGATE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6622
Practice Address - Country:US
Practice Address - Phone:919-544-1300
Practice Address - Fax:919-544-1331
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1884101YA0400X
NC7306,101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104186Medicaid