Provider Demographics
NPI:1619595477
Name:DAVIS, MONEKKA NATAZIA (LCSW-C)
Entity type:Individual
Prefix:
First Name:MONEKKA
Middle Name:NATAZIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MONEKKA
Other - Middle Name:
Other - Last Name:COUNCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6655 SANTA BARBARA RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7500
Mailing Address - Country:US
Mailing Address - Phone:866-968-6342
Mailing Address - Fax:
Practice Address - Street 1:6655 SANTA BARBARA RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7500
Practice Address - Country:US
Practice Address - Phone:866-968-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0277901041C0700X
VA09040174531041C0700X
MD259971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid