MEDICARE: MS. KRISTY A BRYANT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006680	NC

General Provider Information

NPI Number	:	1053642439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTY A BRYANT LCSW

Provider Business Mailing Address
First Line	:	1310 E ARLINGTON BLVD
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5868
Country	:	US
Telephone Number	:	252-321-6306
Fax Number	:	252-355-3689

Provider Business Practice Location Address
First Line	:	1310 E ARLINGTON BLVD
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5868
Country	:	US
Telephone Number	:	252-321-6306
Fax Number	:	252-355-3689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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