Provider Demographics
NPI:1609268937
Name:BRYANT, MEGAN ANTIONETTE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANTIONETTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BUFFALO AVE NW STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4004
Mailing Address - Country:US
Mailing Address - Phone:910-233-6877
Mailing Address - Fax:
Practice Address - Street 1:1 BUFFALO AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4004
Practice Address - Country:US
Practice Address - Phone:910-233-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional