Provider Demographics
NPI:1841426178
Name:BRUNSON, ALICIA (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616-0249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 DAR DR
Practice Address - Street 2:
Practice Address - City:CROSSNORE
Practice Address - State:NC
Practice Address - Zip Code:28616
Practice Address - Country:US
Practice Address - Phone:828-733-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC8740A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor