=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902522311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN MARIE MONOS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2022
-----------------------------------------------------
Last Update Date | 10/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36544 INNISBROOK CIR
-----------------------------------------------------
City | PURCELLVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20132-9010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-786-1114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17333 PICKWICK DR
-----------------------------------------------------
City | PURCELLVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20132-6173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0704015242
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------