Healthcare Provider Details

I. General information

NPI: 1518695014
Provider Name (Legal Business Name): DEVIN M BRUNSTON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BACON ST
PAWTUCKET RI
02860-5542
US

IV. Provider business mailing address

110 CUTLER STREET 1
WARREN RI
02885-1982
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-5280
  • Fax:
Mailing address:
  • Phone: 229-563-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01688
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: