Provider Demographics
NPI:1083695340
Name:GRUBB, MONTY G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONTY
Middle Name:G
Last Name:GRUBB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 MARKET ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8724
Mailing Address - Country:US
Mailing Address - Phone:901-686-4300
Mailing Address - Fax:910-686-3303
Practice Address - Street 1:7946 MARKET ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8724
Practice Address - Country:US
Practice Address - Phone:901-686-4300
Practice Address - Fax:910-686-3303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1529103TA0700X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000492Medicaid
NC1529OtherPSYCHOLOGIST LICENSE NUMB
NC1529OtherPSYCHOLOGIST LICENSE NUMB