Provider Demographics
NPI:1023789708
Name:MCLEMORE, MONICA JOYCE (MA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JOYCE
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4205
Mailing Address - Country:US
Mailing Address - Phone:954-471-2574
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4205
Practice Address - Country:US
Practice Address - Phone:954-471-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL670354101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool