Provider Demographics
NPI:1932640828
Name:RENDLES, MONIQUE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:
Last Name:RENDLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 TASHA DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2095
Mailing Address - Country:US
Mailing Address - Phone:910-674-2456
Mailing Address - Fax:
Practice Address - Street 1:2106 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4226
Practice Address - Country:US
Practice Address - Phone:910-356-9213
Practice Address - Fax:888-356-4522
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12022A106H00000X
NCLMFT2021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist