Provider Demographics
NPI:1356018063
Name:GOLLA, MONICA (LCDC)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:GOLLA
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FERNCROFT CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5765
Mailing Address - Country:US
Mailing Address - Phone:713-851-4296
Mailing Address - Fax:
Practice Address - Street 1:107 FERNCROFT CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-5765
Practice Address - Country:US
Practice Address - Phone:713-851-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)