Provider Demographics
NPI:1164588281
Name:THORNTON, MONIQUE LIPPS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:LIPPS
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20053 JONES LN
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4627
Mailing Address - Country:US
Mailing Address - Phone:985-386-4673
Mailing Address - Fax:
Practice Address - Street 1:20053 JONES LN
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-4627
Practice Address - Country:US
Practice Address - Phone:985-386-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical