Provider Demographics
NPI:1689023483
Name:MONEK, ANITA (LAC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MONEK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7565
Mailing Address - Country:US
Mailing Address - Phone:701-255-3285
Mailing Address - Fax:701-530-0645
Practice Address - Street 1:3315 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7565
Practice Address - Country:US
Practice Address - Phone:701-255-3285
Practice Address - Fax:701-530-0645
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)