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General NPI Number Information
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NPI Number | 1639606171
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Entity Type | Individual
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Provider Name | CHIQUITA MONIQUE CHRISTOFF
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Gender | Female
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 206 CLINIC DR
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City | DONALDSONVILLE
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State | LA
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Zip | 70346
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Country | US
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Telephone | 985-791-7995
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Fax |
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Provider Business Mailing Address
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Address Line | 14351 BRAUD RD
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City | GONZALES
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State | LA
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Zip | 70737-6628
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Country | US
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Telephone | 225-461-8504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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