Provider Demographics
NPI:1003296294
Name:MONTA, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MONTA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LMSW LMFT
Mailing Address - Street 1:1322 ARBOR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3700
Mailing Address - Country:US
Mailing Address - Phone:517-614-2925
Mailing Address - Fax:248-294-1106
Practice Address - Street 1:900 W UNIVERSITY DR STE B2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1817
Practice Address - Country:US
Practice Address - Phone:248-710-0511
Practice Address - Fax:248-294-1106
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM530630139711Medicaid