Individual provider Active NPI

Julianne T. Gold Brunson, PH.D.., HSP-P

  • Clinical Psychologist
  • Charlotte, NC
National Provider Identifier
1487961124
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
102909 Issued in NC
Practice address
4108 Park Road
Charlotte, NC 28209-2563
Phone
(704) 469-5982
Fax
(704) 522-5484
NPI assigned
Sep 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 102909 NC Primary

Addresses

Primary practice location

4108 Park Road
Charlotte, NC 28209-2563

Mailing address

4108 Park Road
Charlotte, NC 28209-2563
Phone (704) 469-5982

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110208000340 NC Practitioner - Clinical Psychologist 7517147564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rha Health Services IncGroup PAC ID 8426196072, 55 clinicians

Practice addresses (Care Compare)

4108 Park Rd
Suite 307
Charlotte, NC 28209-2261
Phone (704) 522-5424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4256NCMDProfessional Counselor
102909NCMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rha Health Services, Inc CurrentSince Sep 20, 2015 Accepting new patients
Rha Health Services, Inc. CurrentSince Sep 20, 2015 Accepting new patients
Rha Health Services Inc Current Accepting new patients
Journey, Inc. Past Accepting new patients

Locations

211 Perimeter Center Pkwy NE
Ste 750
Atlanta, GA 30346

1819 Peachtree Rd NE
Ste 450
Atlanta, GA 30309
Phone (910) 332-5734

4108 Park Rd
Ste 307
Charlotte, NC 28209
Phone (704) 336-6570

211 S Centennial St
High Point, NC 27260
Phone (336) 841-0143

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1487961124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4108 PARK ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092563",
            "telephone_number": "704-469-5982",
            "fax_number": "704-522-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4108 PARK ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092563",
            "telephone_number": "704-469-5982",
            "fax_number": "704-522-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLD BRUNSON",
        "first_name": "JULIANNE",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PH.D.., HSP-P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-01",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "102909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.