Provider Demographics
NPI:1952045593
Name:EASLEY, MONIQUE (MA, CAS)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 CHERRY WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2492
Mailing Address - Country:US
Mailing Address - Phone:301-802-7131
Mailing Address - Fax:
Practice Address - Street 1:2138 PRIEST BRIDGE CT STE 1
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2463
Practice Address - Country:US
Practice Address - Phone:443-584-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health