Provider Demographics
NPI:1821284217
Name:FEARNOT, BRENDA JOYCE (EDS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOYCE
Last Name:FEARNOT
Suffix:
Gender:F
Credentials:EDS, NCC, LPC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JOYCE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-0394
Mailing Address - Country:US
Mailing Address - Phone:252-314-8015
Mailing Address - Fax:
Practice Address - Street 1:5805 SNOOKS TRL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8450
Practice Address - Country:US
Practice Address - Phone:252-314-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4265101YP2500X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool