Provider Demographics
NPI:1053727206
Name:REQUIJO, JOANNE MENSALVAS (LPC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MENSALVAS
Last Name:REQUIJO
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 1:233 12TH STREET SUITE 334
Mailing Address - Street 2:THE PSYCHOLOGY CLINICA
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-5333
Mailing Address - Country:US
Mailing Address - Phone:706-225-0322
Mailing Address - Fax:706-225-0321
Practice Address - Street 1:233 12TH STREET SUITE 334
Practice Address - Street 2:THE PSYCHOLOGY CLINIC
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-5333
Practice Address - Country:US
Practice Address - Phone:706-225-0322
Practice Address - Fax:706-225-0321
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009386101Y00000X
AL3551101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor