MEDICARE: MRS. JANICE PEPPER O'BRYANT M.S,. LPA, LPC

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	101Y00000X	Counselor	2945	NC
2	101YM0800X	Mental Health Counselor	2945	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2945	OTHER	NC	LPC LICENSE
2	2121	OTHER	NC	LICENSED PSYCHOLOGICAL AS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508985482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE PEPPER O'BRYANT M.S,. LPA, LPC

Provider Business Mailing Address
First Line	:	1302 OLD LAMPLIGHTER WAY
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-3430
Country	:	US
Telephone Number	:	910-313-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 OLEANDER DR STE 112
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-4722
Country	:	US
Telephone Number	:	910-769-1785
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/18/2022

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