Healthcare Provider Details

I. General information

NPI: 1437635018
Provider Name (Legal Business Name): NATHAN TUCKER BRUNSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WAKE FOREST RD STE 200
RALEIGH NC
27609-6859
US

IV. Provider business mailing address

67 WILLOW WAY
CHAPEL HILL NC
27516-9469
US

V. Phone/Fax

Practice location:
  • Phone: 213-455-5033
  • Fax: 888-988-1786
Mailing address:
  • Phone: 213-455-5033
  • Fax: 888-988-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: