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General NPI Number Information
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NPI Number | 1295146389
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Entity Type | Organization
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Legal Business Name | MONADNOCK MIND AND BODY
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 3169 NC 8 HWY S AUTUMN SQUARE SUITE #201
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City | WALNUT COVE
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State | NC
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Zip | 27052-5693
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Country | US
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Telephone | 336-409-5178
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Fax | 866-376-2925
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Provider Business Mailing Address
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Address Line | 3169 NC 8 HWY S AUTUMN SQUARE SUITE #201
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City | WALNUT COVE
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State | NC
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Zip | 27052-5693
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Country | US
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Telephone | 336-409-5178
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Fax | 866-376-2925
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. VICKI O MORROW
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Credential | M.D.
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Telephone | 336-409-5178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2012-01667
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License Number State | NC
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