Provider Demographics
NPI:1003248329
Name:BRYAN, AMY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:HARDCASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4000 WAKE FOREST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6879
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:
Practice Address - Street 1:4000 WAKE FOREST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6879
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0085861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical