Healthcare Provider Details

I. General information

NPI: 1780119792
Provider Name (Legal Business Name): KIERRA MONIQUE MUNDINE M.S, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 PINNIX ST # A
GREENSBORO NC
27405-7336
US

IV. Provider business mailing address

201 N MURROW BLVD # 68
GREENSBORO NC
27401-2914
US

V. Phone/Fax

Practice location:
  • Phone: 252-631-0049
  • Fax:
Mailing address:
  • Phone: 252-631-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC4965
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: