Provider Demographics
NPI:1972365021
Name:KENLEY, LONICE MONIQUE (QMHP)
Entity type:Individual
Prefix:
First Name:LONICE
Middle Name:MONIQUE
Last Name:KENLEY
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 RED BAY LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-3471
Mailing Address - Country:US
Mailing Address - Phone:757-404-9320
Mailing Address - Fax:
Practice Address - Street 1:908 RED BAY LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-3471
Practice Address - Country:US
Practice Address - Phone:757-404-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty