Provider Demographics
NPI:1578396008
Name:BRYSON, DANIELLE ASHLEY
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:BRYSON
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 1:103 YUCCA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6853
Mailing Address - Country:US
Mailing Address - Phone:760-362-2884
Mailing Address - Fax:
Practice Address - Street 1:118 CROCKER RD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2226
Practice Address - Country:US
Practice Address - Phone:252-652-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health