Provider Demographics
NPI:1922497379
Name:GRAMBUSCH, MONICA DENISE (MA, LCMHCS, LCAS)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:DENISE
Last Name:GRAMBUSCH
Suffix:
Gender:F
Credentials:MA, LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MEED CT STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2076
Mailing Address - Country:US
Mailing Address - Phone:919-636-5240
Mailing Address - Fax:910-323-1355
Practice Address - Street 1:804 STAMPER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4379
Practice Address - Country:US
Practice Address - Phone:910-323-2875
Practice Address - Fax:910-323-1355
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11238101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor