Provider Demographics
NPI:1154080711
Name:MONROE, TINA (CIT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6729
Mailing Address - Country:US
Mailing Address - Phone:337-345-6122
Mailing Address - Fax:
Practice Address - Street 1:401 W VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6729
Practice Address - Country:US
Practice Address - Phone:337-345-6122
Practice Address - Fax:337-524-1419
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5191101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)