Provider Demographics
NPI:1699381467
Name:GASTON, MONIQUE (LMSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WELL LIFE COUNSELING AND CONSULTING
Mailing Address - Street 2:9649 BELAIR ROAD, STE. 104
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-529-1309
Mailing Address - Fax:410-529-1005
Practice Address - Street 1:WELL LIFE COUNSELING AND CONSULTING
Practice Address - Street 2:9649 BELAIR ROAD, STE. 104
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-529-1309
Practice Address - Fax:410-529-1005
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor