Provider Demographics
NPI:1124526439
Name:NEWSOME, MONIQUE YVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:YVETTE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 TUDOR CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23603-1139
Mailing Address - Country:US
Mailing Address - Phone:757-870-7996
Mailing Address - Fax:
Practice Address - Street 1:522 TUDOR CT
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23603-1139
Practice Address - Country:US
Practice Address - Phone:757-870-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical