Provider Demographics
NPI:1891520474
Name:MASON, MONICA LAVERN (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LAVERN
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LAVERN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3804 STATEFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2517
Mailing Address - Country:US
Mailing Address - Phone:757-319-2381
Mailing Address - Fax:
Practice Address - Street 1:1039 CHAMPIONS WAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3771
Practice Address - Country:US
Practice Address - Phone:757-847-9386
Practice Address - Fax:757-282-2638
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040168611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical