Provider Demographics
NPI:1720261761
Name:KLISZ, MONICA D (LPC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:D
Last Name:KLISZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 NORTHSIDE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5441
Mailing Address - Country:US
Mailing Address - Phone:804-366-4330
Mailing Address - Fax:866-274-9962
Practice Address - Street 1:3111 NORTHSIDE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5441
Practice Address - Country:US
Practice Address - Phone:804-366-4330
Practice Address - Fax:866-274-9962
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional