Crystal Nikia Brunson, LCMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A10494 Issued in NC

Practice address

8376 Six Forks Rd Ste 104
Raleigh, NC 27615-5095

Phone

(919) 900-7438

NPI assigned

Nov 15, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Crystal Nikia Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fernandez Community Center, LLC

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1033465075

  Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1083156582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8376 SIX FORKS RD STE 104",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276155095",
            "telephone_number": "919-900-7438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8376 SIX FORKS RD STE 104",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276155095",
            "telephone_number": "919-900-7438"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8401 Medical Plaza Dr",
            "address_2": "Suite 355",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282628797",
            "country_code": "US",
            "telephone_number": "704-548-5299",
            "fax_number": "704-548-5292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNSON",
        "first_name": "CRYSTAL",
        "middle_name": "NIKIA",
        "credential": "LCMHCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-15",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NC",
            "license": "1167989",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A10494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "GRAY",
            "middle_name": "NIKIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William B Brunk, DDS
• Stephanie Nicole Brunner, PT, DPT
• Keri Ann Bruno, PTA
• Michelle Lea Bruno, LPC, LCMHCS
• Sandra Skellie Bruns, OT/L
• Nathan Tucker Brunson, LCSW
• Rosalind M Brunson
• Mary Elizabeth Brunswick, PA-C
• Julianne Bruskewicz-Trell, DC
• Amy M. Bruton, MD

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.