Provider Demographics
NPI:1215079645
Name:MONDOR, EVA COLLEEN FRANCES (LPC)
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:COLLEEN FRANCES
Last Name:MONDOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:FRANCES EVA
Other - Last Name:MONDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCP
Mailing Address - Street 1:3128 WALTON BLVD. #138
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309
Mailing Address - Country:US
Mailing Address - Phone:248-841-8551
Mailing Address - Fax:586-752-2530
Practice Address - Street 1:3286 KILBURN RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306
Practice Address - Country:US
Practice Address - Phone:248-841-8551
Practice Address - Fax:586-752-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional