Provider Demographics
NPI:1851418735
Name:BRUNER, DARYL (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:BRUNER
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2206
Mailing Address - Country:US
Mailing Address - Phone:704-463-3422
Mailing Address - Fax:
Practice Address - Street 1:48380 HWY 52 N
Practice Address - Street 2:PFEIFFER UNIVERSITY
Practice Address - City:MISENHEIMER
Practice Address - State:NC
Practice Address - Zip Code:28109-0960
Practice Address - Country:US
Practice Address - Phone:704-463-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional