Provider Demographics
NPI:1073389169
Name:PRINCE, MONICA CHARLENE (LMHC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CHARLENE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12003 NW STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-4803
Mailing Address - Country:US
Mailing Address - Phone:352-318-1054
Mailing Address - Fax:
Practice Address - Street 1:12003 NW STATE ROAD 45
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-4803
Practice Address - Country:US
Practice Address - Phone:352-318-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH114487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health