Healthcare Provider Details

I. General information

NPI: 1952313827
Provider Name (Legal Business Name): EDWIN DAVID MUNT M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W WALKER AVE
ASHEBORO NC
27203-6760
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7000
  • Fax: 336-625-3817
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0667
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: