Provider Demographics
NPI:1588988448
Name:MONROE, BRENDA JOYCE (LPC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:MONROE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231A ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2775
Mailing Address - Country:US
Mailing Address - Phone:228-832-2400
Mailing Address - Fax:228-832-2431
Practice Address - Street 1:12231A ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2775
Practice Address - Country:US
Practice Address - Phone:228-832-2400
Practice Address - Fax:228-832-2431
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional