Provider Demographics
NPI:1790552206
Name:MUNERMAN, ELENA (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MUNERMAN
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:MUNERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC-A
Mailing Address - Street 1:211 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5335
Mailing Address - Country:US
Mailing Address - Phone:301-346-7706
Mailing Address - Fax:
Practice Address - Street 1:907 HAY ST STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5352
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:910-483-2876
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1723944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health