Provider Demographics
NPI:1386338598
Name:BRUNSON, MELISSA (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 NORTHERLY WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4309
Mailing Address - Country:US
Mailing Address - Phone:678-231-5990
Mailing Address - Fax:
Practice Address - Street 1:2008 NORTHERLY WAY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-4309
Practice Address - Country:US
Practice Address - Phone:678-231-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health