Provider Demographics
NPI:1528186715
Name:CHURCHILL, MONIQUE M (LMFT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:M
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6037 ALLEGHENY RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7370
Mailing Address - Country:US
Mailing Address - Phone:626-241-7009
Mailing Address - Fax:
Practice Address - Street 1:6037 ALLEGHENY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7370
Practice Address - Country:US
Practice Address - Phone:626-241-7009
Practice Address - Fax:626-241-7009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61300478106H00000X
AZ15227106H00000X
CAIMF46139106H00000X
CAMFC49805106H00000X
VA0717002418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist