Individual
MONIQUE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, LPN, MHP
Contact information
Practice address
300 RED BUD LN, VIENNA, IL 62995-1792
(618) 658-3079
(618) 658-2759
Mailing address
300 RED BUD LN, VIENNA, IL 62995-1792
(618) 658-3079
(618) 658-2759
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
164W00000X
Licensed Practical Nurse
Primary
043123568
IL
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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