Provider Demographics
NPI:1518785559
Name:BRYANT, ASHLEY DEANDRA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEANDRA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 COUNTRY WAY
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8678
Mailing Address - Country:US
Mailing Address - Phone:901-530-7526
Mailing Address - Fax:
Practice Address - Street 1:301 E MEETING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3593
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:828-437-4999
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCA20422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health