MEDICARE: MRS. JOELLEN ESTELLE BRYSON CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	25515	NC

General Provider Information

NPI Number	:	1124789185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOELLEN ESTELLE BRYSON CADC

Provider Business Mailing Address
First Line	:	207 CREST LN
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-2900
Country	:	US
Telephone Number	:	704-297-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	7349 STATESVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3702
Country	:	US
Telephone Number	:	866-966-1168
Fax Number	:

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

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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