Provider Demographics
NPI:1962640748
Name:MOUNT, DAVID L (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MOUNT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 MONTRACHET CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8369
Mailing Address - Country:US
Mailing Address - Phone:336-298-8303
Mailing Address - Fax:
Practice Address - Street 1:450 W HANES MILL RD
Practice Address - Street 2:SUITE NUMBER 224
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9141
Practice Address - Country:US
Practice Address - Phone:336-298-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2821333Medicare PIN