Provider Demographics
NPI:1285124487
Name:GILCREST, MONIQUE MARIE (MS, LPC-I)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:GILCREST
Suffix:
Gender:F
Credentials:MS, LPC-I
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:GILCREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC-I
Mailing Address - Street 1:1205 BRYTON TRCE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3642
Mailing Address - Country:US
Mailing Address - Phone:803-238-8681
Mailing Address - Fax:
Practice Address - Street 1:1205 BRYTON TRCE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3642
Practice Address - Country:US
Practice Address - Phone:803-238-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional