Healthcare Provider Details

I. General information

NPI: 1194525386
Provider Name (Legal Business Name): INDIA MUNOZ LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATESVILLE AVE STE 200
MOORESVILLE NC
28115-2588
US

IV. Provider business mailing address

8300 AMETHYST LN NW APT 8104
CHARLOTTE NC
28262-5060
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-8486
  • Fax:
Mailing address:
  • Phone: 917-362-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21082
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: