=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982356770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L. BRYANT COUNSELING AND CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2022
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2444 COMMERCE RD STE 117
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-7561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-518-8644
-----------------------------------------------------
Fax | 910-685-7766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 WILLARD WAY
-----------------------------------------------------
City | BEULAVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28518-8833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-441-7832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LONTONIA BRYANT
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 910-441-7832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------