Provider Demographics
NPI:1811164338
Name:CAUBLE, MONIQUE BONIFAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:BONIFAY
Last Name:CAUBLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 GEORGIA AVE
Mailing Address - Street 2:CENTER FOR CARE AND COUNSELING FOR THE CSRA INC
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841
Mailing Address - Country:US
Mailing Address - Phone:803-819-9021
Mailing Address - Fax:803-819-9028
Practice Address - Street 1:3551 WHEELER ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:803-819-9021
Practice Address - Fax:803-819-9028
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional