Provider Demographics
NPI:1568098903
Name:NOUR, MONA (LCMHC)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:NOUR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11428 ROYAL AMBER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9896
Mailing Address - Country:US
Mailing Address - Phone:919-306-1234
Mailing Address - Fax:919-551-7568
Practice Address - Street 1:11428 ROYAL AMBER WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-9896
Practice Address - Country:US
Practice Address - Phone:919-306-1234
Practice Address - Fax:919-551-7568
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15628101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15628OtherLICENSED CLINICAL MENTAL HEALTH COUNSELOR