Provider Demographics
NPI:1629475009
Name:BRUNSON, CHRISTI SAMANTHA
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:SAMANTHA
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 GREENSBORO STREET EXT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-1924
Mailing Address - Country:US
Mailing Address - Phone:336-249-0237
Mailing Address - Fax:336-243-7685
Practice Address - Street 1:6135 PARK SOUTH DR STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3272
Practice Address - Country:US
Practice Address - Phone:704-810-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10969101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional