Provider Demographics
NPI:1801395819
Name:BRYANT, MIRIYA MECHAE (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:MIRIYA
Middle Name:MECHAE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 OLD WIRE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28351-9718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6870 OLD WIRE RD
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:NC
Practice Address - Zip Code:28351-9718
Practice Address - Country:US
Practice Address - Phone:910-280-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0117761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical