Healthcare Provider Details

I. General information

NPI: 1255990263
Provider Name (Legal Business Name): MONIQUE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 PRIDE DR STE B
HAMMOND LA
70401-9527
US

IV. Provider business mailing address

835 PRIDE DR STE B
HAMMOND LA
70401-9527
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-4333
  • Fax:
Mailing address:
  • Phone: 985-543-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11149
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: