Provider Demographics
NPI:1184013922
Name:DANCE, MONTAKIA PRINCESS (LAPC)
Entity Type:Individual
Prefix:MRS
First Name:MONTAKIA
Middle Name:PRINCESS
Last Name:DANCE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 RIVER BEND WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5838
Mailing Address - Country:US
Mailing Address - Phone:678-234-7999
Mailing Address - Fax:
Practice Address - Street 1:9876 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3990
Practice Address - Country:US
Practice Address - Phone:678-234-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional