Provider Demographics
NPI:1649089889
Name:BRYANT, MADELINE ADGER (LCAS/LCSWA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ADGER
Last Name:BRYANT
Suffix:
Gender:
Credentials:LCAS/LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CASCADE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-8645
Mailing Address - Country:US
Mailing Address - Phone:843-729-5394
Mailing Address - Fax:
Practice Address - Street 1:637 CASCADE LAKE RD
Practice Address - Street 2:
Practice Address - City:PISGAH FOREST
Practice Address - State:NC
Practice Address - Zip Code:28768-8645
Practice Address - Country:US
Practice Address - Phone:239-770-1286
Practice Address - Fax:828-202-8104
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169511041C0700X
NC27834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical