Provider Demographics
NPI:1487209581
Name:RELERFORD, MONKEIDA PHALET
Entity Type:Individual
Prefix:
First Name:MONKEIDA
Middle Name:PHALET
Last Name:RELERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONKEIDA
Other - Middle Name:PHALET
Other - Last Name:LUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2189 MAPLEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-7811
Mailing Address - Country:US
Mailing Address - Phone:810-853-8722
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1552
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801109259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker