Individual provider · NPI-1

Jenna Brunner, LCMHCA

Counselor, Mental Health · Charlotte, NC

NPI number1558095984
StatusActive
Last updated in NPPESJul 12, 2022

Details

NPI
1558095984
Entity type
Individual (NPI-1)
Name
Jenna Brunner
Credential
LCMHCA
Sex
Female
Sole proprietor
No
Enumeration date
Jul 12, 2022
Certification date
Jul 12, 2022
Last updated
Jul 12, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental HealthA17742NCYes
225C00000X Rehabilitation Counselor597178NC

Practice location

4730 Park Road
Suite A, C
Charlotte, NC 28209

Phone 704-800-4436

Mailing address

4730 Park Rd Ste A
Charlotte, NC 28209-4205

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