| Doctor Name: | DR. ANNQUNETTA MARIE MUNDY |
| NPI Number: | 1063625432 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC,,PH.D |
| License Number: | 6401009343 |
| Business Practice Address: | 1406 8th St Port Huron, MI - 480605804 |
| Business Phone Number: | 8109871258 |
| Business Fax Number: | 8109873505 |
| Mailing Address: | 32225 29 Mile Rd, LENOX |
| State: | MI |
| Postal Code: | 480502413 |
| Phone Number: | 3134779776 |
| Fax Number: | |
| NPI Enumeration Date: | 05/08/2007 |
| NPI Last Update Date: | 04/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401009343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |