Provider Demographics
NPI:1487634507
Name:CREQUE, HALIMENA MONTCLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:HALIMENA
Middle Name:MONTCLAIRE
Last Name:CREQUE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 BETHESDA PLACE #801
Mailing Address - Street 2:FAMILY BEHAVIORAL HEALTH
Mailing Address - City:WINSTON- SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-659-9141
Mailing Address - Fax:336-659-1456
Practice Address - Street 1:3000 BETHESDA PLACE #801
Practice Address - Street 2:FAMILY BEHAVIORAL HEALTH
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-659-9141
Practice Address - Fax:336-659-1456
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC303192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925734Medicaid
NC8925734Medicaid
NCBC1644257Other(DEA)
NCBC1644257Other(DEA)
NCD92765Medicare UPIN
NC212130EMedicare Oscar/Certification