Individual
JENNA BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
4730 PARK ROAD, SUITE A, C, CHARLOTTE, NC 28209
(704) 800-4436
Mailing address
4730 PARK RD STE A, CHARLOTTE, NC 28209-4205
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A17742
NC
225C00000X
Rehabilitation Counselor
597178
NC
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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