Provider Demographics
NPI:1457523318
Name:DEELY, MONIQUE JEANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:JEANNE
Last Name:DEELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:JEANNE
Other - Last Name:TARDIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:625 SLATERS LN STE 103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1176
Mailing Address - Country:US
Mailing Address - Phone:571-800-9909
Mailing Address - Fax:
Practice Address - Street 1:634 PUTNAM PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-4018
Practice Address - Country:US
Practice Address - Phone:404-409-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040091941041C0700X
GACSW0039101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical