Provider Demographics
NPI:1295165892
Name:MUNKITTRICK, MEGAN MURPHY
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MURPHY
Last Name:MUNKITTRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LAUREL
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3937 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1936
Mailing Address - Country:US
Mailing Address - Phone:919-821-0790
Mailing Address - Fax:
Practice Address - Street 1:3937 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1936
Practice Address - Country:US
Practice Address - Phone:919-821-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health