Provider Demographics
NPI:1710399076
Name:KEENE-KING, MONIQUE (MED, LCPC, ACS,NCC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:KEENE-KING
Suffix:
Gender:F
Credentials:MED, LCPC, ACS,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12908 VICTORIA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3015
Mailing Address - Country:US
Mailing Address - Phone:301-352-5505
Mailing Address - Fax:
Practice Address - Street 1:12908 VICTORIA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3015
Practice Address - Country:US
Practice Address - Phone:301-352-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional