Provider Demographics
NPI:1598187205
Name:CHURCH, MONIQUE (LCSW-C, CEAP, SAP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:LCSW-C, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 ROLLING RD.
Mailing Address - Street 2:UNIT 5B
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2251
Mailing Address - Country:US
Mailing Address - Phone:410-521-8137
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical