Provider Demographics
NPI:1881351369
Name:SPEIGHT, BRYAN JEROME (MSW, LCSWA)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JEROME
Last Name:SPEIGHT
Suffix:
Gender:M
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 1:9600 HIGH FALLS LN APT 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1130
Mailing Address - Country:US
Mailing Address - Phone:252-363-1781
Mailing Address - Fax:
Practice Address - Street 1:4000 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2832
Practice Address - Country:US
Practice Address - Phone:704-523-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical