Provider Demographics
NPI:1659007573
Name:BRYANT, SKYLAR ALEXA (MSW, LCAS-A)
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:ALEXA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4972 RED HILL RD APT 115
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-6462
Mailing Address - Country:US
Mailing Address - Phone:812-430-7971
Mailing Address - Fax:
Practice Address - Street 1:4719 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2113
Practice Address - Country:US
Practice Address - Phone:910-739-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27728101YA0400X
NCP0183811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)