=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083695340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONTY G. GRUBB PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7946 MARKET ST SUITE 500
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28411-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-686-4300
-----------------------------------------------------
Fax | 910-686-3303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7946 MARKET ST SUITE 500
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28411-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-686-4300
-----------------------------------------------------
Fax | 910-686-3303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TA0700X
-----------------------------------------------------
Taxonomy Name | Adult Development & Aging Psychologist
-----------------------------------------------------
License Number | 1529
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | 1529
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1529
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------