Provider Demographics
NPI:1023323706
Name:BIVINS, MONIQUE Y (LPC)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:Y
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C6 CONCORD HOUSE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1068
Mailing Address - Country:US
Mailing Address - Phone:814-282-5452
Mailing Address - Fax:
Practice Address - Street 1:15667 STATE HWY 86
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-5317
Practice Address - Country:US
Practice Address - Phone:814-282-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional