Healthcare Provider Details

I. General information

NPI: 1801383617
Provider Name (Legal Business Name): JAMES WADELL BRUNSON JR. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

1629 K ST NW
WASHINGTON DC
20006-1602
US

V. Phone/Fax

Practice location:
  • Phone: 202-835-0680
  • Fax:
Mailing address:
  • Phone: 202-835-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: