Individual
BRYAN EDWARD CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3020 PROSPERITY CHURCH RD, STE J, CHARLOTTE, NC 28269-8100
(704) 641-0273
(704) 625-9182
Mailing address
3020 PROSPERITY CHURCH RD, STE J, CHARLOTTE, NC 28269-8100
(704) 641-0273
(704) 625-9182
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1681
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0486J
BCBSNC
NC
05
—
6000586
—
NC
01
—
61-00069
EVERCARE
—
Enumeration date
08/22/2005
Last updated
06/25/2018
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