Provider Demographics
NPI:1083947519
Name:CONNER, MONICA RENEE (MS, LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MS, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 COURTIER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7818
Mailing Address - Country:US
Mailing Address - Phone:252-752-0483
Mailing Address - Fax:252-757-3174
Practice Address - Street 1:2602 COURTIER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7818
Practice Address - Country:US
Practice Address - Phone:252-355-4725
Practice Address - Fax:252-355-0444
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPROVISIONAL101Y00000X
NC00100749225C00000X
1543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor