Provider Demographics
NPI:1417277096
Name:DAKE, MONIQUE TERESE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:TERESE
Last Name:DAKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:TERESE
Other - Last Name:ARSNEAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:307 CHILSON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7434
Mailing Address - Country:US
Mailing Address - Phone:248-884-2354
Mailing Address - Fax:
Practice Address - Street 1:307 CHILSON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:248-884-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68010924201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)