Basic Information
| Provider Information | |||||||||
| NPI: | 1629475009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNSON | ||||||||
| FirstName: | CHRISTI | ||||||||
| MiddleName: | SAMANTHA | ||||||||
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| Credential: | MS, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 GREENSBORO STREET EXT | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272951924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362490237 | ||||||||
| FaxNumber: | 3362437685 | ||||||||
| Practice Location | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2014 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | A10969 | NC | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 10969 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.