Provider Demographics
NPI:1881051993
Name:MICELI, MONICA (LAC)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:MICELI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 E BROOKSTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-4603
Mailing Address - Country:US
Mailing Address - Phone:225-927-0770
Mailing Address - Fax:225-927-0771
Practice Address - Street 1:4255 E BROOKSTOWN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4603
Practice Address - Country:US
Practice Address - Phone:225-927-0770
Practice Address - Fax:225-927-0771
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)