Provider Demographics
NPI:1033549910
Name:BRUIN, CHRISTINE URBAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:URBAN
Last Name:BRUIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HAUSMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 MILITARY CUTOFF RD.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405
Mailing Address - Country:US
Mailing Address - Phone:910-254-4818
Mailing Address - Fax:910-254-4819
Practice Address - Street 1:510 MILITARY CUTOFF RD.
Practice Address - Street 2:SUITE 120
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-254-4818
Practice Address - Fax:910-254-4819
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist