Provider Demographics
NPI:1902212137
Name:BRUINGTON, CRISTINA (LMFT, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:BRUINGTON
Suffix:
Gender:F
Credentials:LMFT, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 HICKORYWOOD HILL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3474
Mailing Address - Country:US
Mailing Address - Phone:704-999-0505
Mailing Address - Fax:
Practice Address - Street 1:10224 HICKORYWOOD HILL AVE STE 205
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3474
Practice Address - Country:US
Practice Address - Phone:704-999-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22663101YA0400X
NC1958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19M5UOtherBLUE CROSS BLUE SHIELD