Provider Demographics
NPI: | 1669866208 |
---|---|
Name: | BRYANT, YOLANDA PATRICE (MS, LPC, LCAS-A) |
Entity Type: | Individual |
Prefix: | |
First Name: | YOLANDA |
Middle Name: | PATRICE |
Last Name: | BRYANT |
Suffix: | |
Gender: | F |
Credentials: | MS, LPC, 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: | PO BOX 31062 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27833-1062 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-916-6048 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3106 S MEMORIAL DR STE B |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27834-6765 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-916-6048 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-03-21 |
Last Update Date: | 2018-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 11450 | 101YP2500X, 101YM0800X |
NC | 21996 | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |