Provider Demographics
NPI:1164547493
Name:ATKINS, MONIQUE HERING (PSYD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:HERING
Last Name:ATKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARVELLE
Other - Middle Name:MONIQUE
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MAILSTOP #140
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-699-2350
Mailing Address - Fax:323-671-3843
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILSTOP #140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-699-2350
Practice Address - Fax:323-671-3843
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist