Provider Demographics
NPI:1003847799
Name:MILLS-MATTOX, MONICA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MARIE
Last Name:MILLS-MATTOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1050 S JEFF DAVIS PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1250
Mailing Address - Country:US
Mailing Address - Phone:832-725-0586
Mailing Address - Fax:888-977-1299
Practice Address - Street 1:1050 S JEFF DAVIS PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1250
Practice Address - Country:US
Practice Address - Phone:832-725-0586
Practice Address - Fax:888-977-1299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330831041C0700X
LA128551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical