Provider Demographics
NPI:1659196970
Name:MIDDLETON, MONIQUE TAYLOR (LCMHC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:TAYLOR
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:312 AUGUSTUS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-7702
Mailing Address - Country:US
Mailing Address - Phone:704-641-4489
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 400
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2965
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:929-596-7897
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health