Provider Demographics
NPI:1972789972
Name:MCMORRIS, MONIQUE MARIE (CADC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:MCMORRIS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 WALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3460
Mailing Address - Country:US
Mailing Address - Phone:510-860-2163
Mailing Address - Fax:
Practice Address - Street 1:208 23RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1830
Practice Address - Country:US
Practice Address - Phone:510-216-4601
Practice Address - Fax:510-680-0346
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC13001214101YA0400X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)