Provider Demographics
NPI:1346867892
Name:MUNDY, ADREEONAH ALICE
Entity Type:Individual
Prefix:
First Name:ADREEONAH
Middle Name:ALICE
Last Name:MUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 OLD 'YORK RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3247
Mailing Address - Country:US
Mailing Address - Phone:215-376-6200
Mailing Address - Fax:215-376-6191
Practice Address - Street 1:610 OLD YORK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3247
Practice Address - Country:US
Practice Address - Phone:215-376-6200
Practice Address - Fax:215-376-6191
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012419OtherPROFESSIONAL COUNSELOR