Provider Demographics
NPI:1508618851
Name:SMOCK, SHENEL MONIQUE
Entity Type:Individual
Prefix:
First Name:SHENEL
Middle Name:MONIQUE
Last Name:SMOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 HANNIBAL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-5531
Mailing Address - Country:US
Mailing Address - Phone:404-539-8063
Mailing Address - Fax:
Practice Address - Street 1:4712 HANNIBAL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-5531
Practice Address - Country:US
Practice Address - Phone:720-598-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health