MEDICARE: MELISSA BRYSON

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	101YM0800X	Mental Health Counselor	A18044	NC

General Provider Information

NPI Number	:	1083319891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BRYSON

Provider Business Mailing Address
First Line	:	1052 DELRIDGE ST
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-4560
Country	:	US
Telephone Number	:	980-395-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	4712 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2508
Country	:	US
Telephone Number	:	704-281-8146
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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Directions to “ MELISSA BRYSON ” Practice Location

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