Provider Demographics
NPI:1033733084
Name:DORNICK, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DORNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 15TH ST
Mailing Address - Street 2:STE C, #3173
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4542
Mailing Address - Country:US
Mailing Address - Phone:760-613-9788
Mailing Address - Fax:
Practice Address - Street 1:2100 N SEPULVEDA BLVD STE 31
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2958
Practice Address - Country:US
Practice Address - Phone:310-987-7638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA126561106H00000X
CA144501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)