Provider Demographics
NPI:1790450633
Name:VAN DEVENTER, MONICA RENEE (MS, NCC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:VAN DEVENTER
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BELCOURT PKWY APT 1515
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2160
Mailing Address - Country:US
Mailing Address - Phone:706-312-4322
Mailing Address - Fax:
Practice Address - Street 1:45 W CROSSVILLE RD STE 510
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:770-702-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health