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General NPI Number Information
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NPI Number | 1659196970
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Entity Type | Individual
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Provider Name | MONIQUE TAYLOR MIDDLETON LCMHC
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 8601 SIX FORKS RD STE 400
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City | RALEIGH
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State | NC
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Zip | 27615-2965
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 312 AUGUSTUS LN
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City | MOUNT HOLLY
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State | NC
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Zip | 28120-7702
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Country | US
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Telephone | 704-641-4489
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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 | 13947
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License Number State | NC
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