Provider Demographics
NPI:1982993549
Name:BRYAN, TAMELA JOAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMELA
Middle Name:JOAN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC BOX 21001
Mailing Address - Street 2:MARINE & FAMILY SERVICES
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28545-1001
Mailing Address - Country:US
Mailing Address - Phone:910-449-5241
Mailing Address - Fax:910-449-6240
Practice Address - Street 1:205 DAYRELL DR
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-4405
Practice Address - Country:US
Practice Address - Phone:910-934-3433
Practice Address - Fax:910-449-6240
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC C0069101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical