Healthcare Provider Details

I. General information

NPI: 1982527784
Provider Name (Legal Business Name): MONIQUE A HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAIRY RD
WEST MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

215 LAGO CIR APT 100
WEST MELBOURNE FL
32904-3354
US

V. Phone/Fax

Practice location:
  • Phone: 321-256-8000
  • Fax:
Mailing address:
  • Phone: 321-720-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: