Provider Demographics
NPI:1760980569
Name:DUNNING, BRETT AARON (LCAS)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:AARON
Last Name:DUNNING
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 HARBOUR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-8658
Mailing Address - Country:US
Mailing Address - Phone:252-722-6534
Mailing Address - Fax:
Practice Address - Street 1:3512 VIRGINIA DARE TRL N
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-4079
Practice Address - Country:US
Practice Address - Phone:252-715-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLCAS-21556OtherNORTH CAROLINA SUBSTANCE ABUSE PRACTICE BOARD