Healthcare Provider Details

I. General information

NPI: 1659005627
Provider Name (Legal Business Name): SAMUEL WILLIAM BRYANT MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 MERIDIAN PKWY STE 115
DURHAM NC
27713-5273
US

IV. Provider business mailing address

1143 EXECUTIVE CIR STE A
CARY NC
27511-4571
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax:
Mailing address:
  • Phone: 207-446-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018673
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: