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General NPI Number Information
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NPI Number | 1417071077
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Entity Type | Individual
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Provider Name | DWAN T MONTGOMERY LPC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 1309 NORTHUP ST SUITE D
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City | REIDSVILLE
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State | NC
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Zip | 27320-5611
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Country | US
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Telephone | 704-808-0400
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Fax | 336-791-4480
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | EDEN
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State | NC
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Zip | 27289-0014
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Country | US
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Telephone | 704-808-0400
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Fax | 336-791-4480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6488
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License Number State | NC
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