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Provider Information for 1598187205


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MONIQUE CHURCH LCSW-C, CEAP, SAP


Sex: Female

NPI: 1598187205
Last Updated: 2014-01-29
Certification Date:

Details

NameValue
NPI1598187205
Enumeration Date2014-01-15
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 3924 ROLLING RD.
UNIT 5B
PIKESVILLE, MD 21208-2251
United States

Phone: 410-521-8137 | Fax:
 
Primary Practice Address 419 W REDWOOD ST
BALTIMORE, MD 21201-1734
United States

Phone: 410-328-6106 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMD14778