Provider Demographics
NPI:1972789014
Name:BRYAN, JANINE ROLISON (LCMHC)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:ROLISON
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 BELLASTEAD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1093
Mailing Address - Country:US
Mailing Address - Phone:704-813-1300
Mailing Address - Fax:
Practice Address - Street 1:6110 BELLASTEAD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-1093
Practice Address - Country:US
Practice Address - Phone:704-384-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12588101YM0800X
SCLPC4633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health