Healthcare Provider Details

I. General information

NPI: 1083695340
Provider Name (Legal Business Name): MONTY G. GRUBB PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7946 MARKET ST SUITE 500
WILMINGTON NC
28411-8724
US

IV. Provider business mailing address

7946 MARKET ST SUITE 500
WILMINGTON NC
28411-8724
US

V. Phone/Fax

Practice location:
  • Phone: 901-686-4300
  • Fax: 910-686-3303
Mailing address:
  • Phone: 901-686-4300
  • Fax: 910-686-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1529
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1529
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: