Provider Demographics
NPI:1376062539
Name:DARNELL, MONIQUE R (LPC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:R
Last Name:DARNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LANIER AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7443
Mailing Address - Country:US
Mailing Address - Phone:404-919-8222
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:320 LANIER AVE W STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7443
Practice Address - Country:US
Practice Address - Phone:404-919-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18174101YM0800X
GALPC011474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056397273OtherDRIVER LICENSE