Provider Demographics
NPI:1316933393
Name:BIES, BRITAN BONJOUR (MA, LPA)
Entity type:Individual
Prefix:MS
First Name:BRITAN
Middle Name:BONJOUR
Last Name:BIES
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:MRS
Other - First Name:BRITAN
Other - Middle Name:
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:75 HAMPSTEAD VLG
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8250
Mailing Address - Country:US
Mailing Address - Phone:910-270-3811
Mailing Address - Fax:910-270-3897
Practice Address - Street 1:75 HAMPSTEAD VLG
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8250
Practice Address - Country:US
Practice Address - Phone:910-270-3811
Practice Address - Fax:910-270-3897
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2467103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107244Medicaid
NC046E3OtherBCBS