Provider Demographics
NPI:1083367163
Name:DANIELS, MONIQUE JESHIRL
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:JESHIRL
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCAS, LCMHCA
Mailing Address - Street 1:842 ROYAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9964
Mailing Address - Country:US
Mailing Address - Phone:919-685-6337
Mailing Address - Fax:
Practice Address - Street 1:249 E NC HIGHWAY 54 STE 320
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2490
Practice Address - Country:US
Practice Address - Phone:919-685-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)