Provider Demographics
NPI:1922851773
Name:SPURLOCK, MONIQUE TERESE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:TERESE
Last Name:SPURLOCK
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 1:15001 KERCHEVAL AVE UNIT 2018
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1361
Mailing Address - Country:US
Mailing Address - Phone:313-463-1873
Mailing Address - Fax:
Practice Address - Street 1:15001 KERCHEVAL AVE UNIT 2018
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1361
Practice Address - Country:US
Practice Address - Phone:313-463-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor