Jacqueline Fadeyi-Bryant, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C002905 Issued in NC

Practice address

200 Valencia Dr
Jacksonville, NC 28546-6311

Phone

(910) 353-3060

Fax

(910) 353-3080

NPI assigned

Dec 23, 2006

Last updated

Feb 17, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1558426213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466311",
            "telephone_number": "910-353-3060",
            "fax_number": "910-353-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466311",
            "telephone_number": "910-353-3060",
            "fax_number": "910-353-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADEYI-BRYANT",
        "first_name": "JACQUELINE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-23",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C002905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.