Provider Demographics
NPI:1659737740
Name:ELLIOTT, VONZOLLA MONIQUE
Entity Type:Individual
Prefix:
First Name:VONZOLLA
Middle Name:MONIQUE
Last Name:ELLIOTT
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 1:8515 BOULEVARD 26 APT 209
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5632
Mailing Address - Country:US
Mailing Address - Phone:504-289-1067
Mailing Address - Fax:317-723-3632
Practice Address - Street 1:429 E VERMONT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3690
Practice Address - Country:US
Practice Address - Phone:317-723-3181
Practice Address - Fax:317-723-3632
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010927901041C0700X
IN34007952A1041C0700X
WALW607506461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty