Provider Demographics
NPI:1487698650
Name:HORNE, BRYAN M (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:M
Last Name:HORNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 NORTH NC HWY 41
Mailing Address - Street 2:PO BOX 1321
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518
Mailing Address - Country:US
Mailing Address - Phone:910-298-6207
Mailing Address - Fax:910-298-6293
Practice Address - Street 1:191 NORTH NC HWY 41
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-6207
Practice Address - Fax:910-298-6293
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGOtherNEWLY LICENSED INDIVIDUAL