MEDICARE: CHRISTI SAMANTHA BRUNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	10969	NC
2	101YP2500X	Professional Counselor	10969	NC

General Provider Information

NPI Number	:	1629475009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTI SAMANTHA BRUNSON

Provider Business Mailing Address
First Line	:	1303 GREENSBORO STREET EXT
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-1924
Country	:	US
Telephone Number	:	336-249-0237
Fax Number	:	336-243-7685

Provider Business Practice Location Address
First Line	:	6135 PARK SOUTH DR STE 105
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3272
Country	:	US
Telephone Number	:	704-810-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	08/13/2025

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Directions to “ CHRISTI SAMANTHA BRUNSON ” Practice Location

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