Provider Demographics
NPI:1780119792
Name:MUNDINE, KIERRA (MS, LCMHCA)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:MUNDINE
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 S GLENBURNIE RD UNIT 13163
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-0052
Mailing Address - Country:US
Mailing Address - Phone:252-631-0049
Mailing Address - Fax:
Practice Address - Street 1:1715 US HIGHWAY 17 N LOT 9
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5045
Practice Address - Country:US
Practice Address - Phone:252-631-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12900101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health