Provider Demographics
NPI:1174987671
Name:BRUNO, MICHELLE LEA (LPC, LCMHCS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LPC, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 FAIRSTED DRIVE
Mailing Address - Street 2:APT 617
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4591
Mailing Address - Country:US
Mailing Address - Phone:412-302-4901
Mailing Address - Fax:
Practice Address - Street 1:3950 FAIRSTED DRIVE
Practice Address - Street 2:APT 617
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4591
Practice Address - Country:US
Practice Address - Phone:413-202-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC517622101YM0800X
101YM0800X
PAPC006076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health