Provider Demographics
NPI:1447682562
Name:BRUNSON, ELIZABETH F (MS/EDS, LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:MS/EDS, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 DONEGAL CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8663
Mailing Address - Country:US
Mailing Address - Phone:919-244-9580
Mailing Address - Fax:
Practice Address - Street 1:138 S CHERRY ST STE 400
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5271
Practice Address - Country:US
Practice Address - Phone:919-244-9580
Practice Address - Fax:336-450-1907
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9265101YM0800X
NCA9265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health